Provider Demographics
NPI:1396741583
Name:ECHOLS, SAMUEL LEE (PT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:LEE
Last Name:ECHOLS
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:PO BOX 1975
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-1975
Mailing Address - Country:US
Mailing Address - Phone:706-346-6035
Mailing Address - Fax:866-858-7371
Practice Address - Street 1:519 BROAD ST STE 300
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-1736
Practice Address - Country:US
Practice Address - Phone:706-346-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000802645T,R,U,V,W,XMedicaid
GA000802645C,E,L,M,N,PMedicaid
GAP00319887OtherRR MEDICARE
GA000802645T,R,U,V,W,XMedicaid