Provider Demographics
NPI:1659923936
Name:BURWELL, SAMUEL WILLIAM III
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:WILLIAM
Last Name:BURWELL
Suffix:III
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 1:1945 LAVEER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-1403
Mailing Address - Country:US
Mailing Address - Phone:267-591-0144
Mailing Address - Fax:
Practice Address - Street 1:1945 LAVEER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-1403
Practice Address - Country:US
Practice Address - Phone:267-591-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer