Provider Demographics
NPI:1750976767
Name:SAMPSON, JOHN FRANCIS III
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANCIS
Last Name:SAMPSON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4745
Mailing Address - Country:US
Mailing Address - Phone:860-878-4940
Mailing Address - Fax:
Practice Address - Street 1:277 TREMONT ST
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4745
Practice Address - Country:US
Practice Address - Phone:860-878-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10781225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist