Provider Demographics
NPI:1396954061
Name:SAMKO, PHILIP WILLIAM (PT ATC)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:WILLIAM
Last Name:SAMKO
Suffix:
Gender:M
Credentials:PT ATC
Other - Prefix:
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Mailing Address - Street 1:216 WELSH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08031
Mailing Address - Country:US
Mailing Address - Phone:856-419-2163
Mailing Address - Fax:215-898-9296
Practice Address - Street 1:235 SO 33RD ST
Practice Address - Street 2:UNIV OF PENNSYLVANIA WEIGHTMAN MALL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-898-2822
Practice Address - Fax:215-898-2822
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJAOQA00356000225100000X
PART000317A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer