Provider Demographics
NPI:1942291760
Name:AMARIA, ARIZ SAM (RPT)
Entity Type:Individual
Prefix:MR
First Name:ARIZ
Middle Name:SAM
Last Name:AMARIA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-494-3008
Practice Address - Street 1:SOUTHERN ORTHOPEDIC SPECIALIST PA
Practice Address - Street 2:1827 HARRISON AVENUE BLDG# 4
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405
Practice Address - Country:US
Practice Address - Phone:850-872-7022
Practice Address - Fax:850-872-7021
Is Sole Proprietor?:No
Enumeration Date:2005-11-01
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY044GZMedicare ID - Type Unspecified