Provider Demographics
NPI:1750757399
Name:CIDEL-SAMUEL, MARIE NAHOMIE (PT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:NAHOMIE
Last Name:CIDEL-SAMUEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-5402
Mailing Address - Country:US
Mailing Address - Phone:615-792-4948
Mailing Address - Fax:
Practice Address - Street 1:2501 RIVER RD
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-5402
Practice Address - Country:US
Practice Address - Phone:615-792-4948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8310225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist