Provider Demographics
NPI:1023280187
Name:LAVARIAS, SAMUEL (PT,DPT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:LAVARIAS
Suffix:
Gender:M
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 1:829 DELTONA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7132
Mailing Address - Country:US
Mailing Address - Phone:386-259-9838
Mailing Address - Fax:386-259-9834
Practice Address - Street 1:829 DELTONA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7132
Practice Address - Country:US
Practice Address - Phone:386-259-9838
Practice Address - Fax:386-259-9834
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-29
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist