Provider Demographics
NPI:1689204752
Name:SAMUEL, SUSANNA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SUSANNA
Middle Name:
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 POINTED LEAF DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1599
Mailing Address - Country:US
Mailing Address - Phone:281-770-2265
Mailing Address - Fax:
Practice Address - Street 1:4600 FAIRMONT PKWY STE 205
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3337
Practice Address - Country:US
Practice Address - Phone:281-998-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1324650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist