Provider Demographics
NPI:1780203539
Name:ADRIGNOLA, SAMUEL (DPT)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:ADRIGNOLA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W ELDRED ST
Mailing Address - Street 2:STE 101
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4282
Mailing Address - Country:US
Mailing Address - Phone:314-591-4928
Mailing Address - Fax:
Practice Address - Street 1:2939 CROCKETT ST APT 245
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2953
Practice Address - Country:US
Practice Address - Phone:314-591-4928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-12
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1273886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist