Provider Demographics
NPI:1821368143
Name:DOSS, SAMUEL ZACHARY (PT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ZACHARY
Last Name:DOSS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 E TACOMA ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-4915
Mailing Address - Country:US
Mailing Address - Phone:918-527-2519
Mailing Address - Fax:
Practice Address - Street 1:2896 HUBER RD STE A
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-2292
Practice Address - Country:US
Practice Address - Phone:830-461-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1180420225100000X
OK3792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3792OtherOKLAHOMA BOARD OF PHYSICAL THERAPY