Provider Demographics
NPI:1629796933
Name:JARAMILLO, SAMUEL (DPT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:JARAMILLO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:5002 GRAND LAKES DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-4214
Mailing Address - Country:US
Mailing Address - Phone:904-238-7831
Mailing Address - Fax:
Practice Address - Street 1:460 BOULEVARD WAY STE 2D
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94610-1563
Practice Address - Country:US
Practice Address - Phone:510-922-8872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPTL00186252251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic