Provider Demographics
NPI:1760515282
Name:SAMS, MICHAEL TODD (MPT, OCS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:SAMS
Suffix:
Gender:M
Credentials:MPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21621 21ST ST E
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6226
Mailing Address - Country:US
Mailing Address - Phone:253-682-6305
Mailing Address - Fax:
Practice Address - Street 1:1 N TACOMA AVE
Practice Address - Street 2:STE 103
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98403-3131
Practice Address - Country:US
Practice Address - Phone:253-274-1884
Practice Address - Fax:253-274-1885
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT000063372251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7121973Medicaid
WA7121973Medicaid