Provider Demographics
NPI:1891304614
Name:SAMAR, MICHELLE DAYLO (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DAYLO
Last Name:SAMAR
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 EXECUTIVE DR APT 3301
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-0255
Mailing Address - Country:US
Mailing Address - Phone:704-689-1316
Mailing Address - Fax:
Practice Address - Street 1:680 EXECUTIVE DR APT 3301
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-0255
Practice Address - Country:US
Practice Address - Phone:704-689-1316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1285000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist