Provider Demographics
NPI:1629628599
Name:SPATES, SAMUEL JESSE
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JESSE
Last Name:SPATES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8902 STEPHEN F AUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:77541-9781
Mailing Address - Country:US
Mailing Address - Phone:972-268-4410
Mailing Address - Fax:
Practice Address - Street 1:8902 STEPHEN F AUSTIN RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:TX
Practice Address - Zip Code:77541-9781
Practice Address - Country:US
Practice Address - Phone:972-268-4410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant