Provider Demographics
NPI:1861460362
Name:SAMUEL, ELIZABETH PAIGE (MPT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PAIGE
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 WOODCREEK RD
Mailing Address - Street 2:
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-2062
Mailing Address - Country:US
Mailing Address - Phone:609-206-7708
Mailing Address - Fax:
Practice Address - Street 1:542 BERLIN CROSS KEYS RD
Practice Address - Street 2:WINSLOW PLAZA, SUITE 1
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-4367
Practice Address - Country:US
Practice Address - Phone:856-740-0009
Practice Address - Fax:856-262-0469
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00993000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist