Provider Demographics
NPI:1942521737
Name:SAMUEL, JOBY ((PT))
Entity Type:Individual
Prefix:
First Name:JOBY
Middle Name:
Last Name:SAMUEL
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 1:5771 ENID ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-1208
Mailing Address - Country:US
Mailing Address - Phone:713-880-4400
Mailing Address - Fax:713-869-8637
Practice Address - Street 1:12741 EAST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5605
Practice Address - Country:US
Practice Address - Phone:713-453-7788
Practice Address - Fax:713-453-3424
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1155530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist