Provider Demographics
NPI:1710755228
Name:SAMPSON, THOMAS (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NY
Mailing Address - Zip Code:14892-9718
Mailing Address - Country:US
Mailing Address - Phone:607-565-3942
Mailing Address - Fax:
Practice Address - Street 1:379 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:NY
Practice Address - Zip Code:14892-9718
Practice Address - Country:US
Practice Address - Phone:607-565-3942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG013135225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist