Provider Demographics
NPI:1780929299
Name:DIGIOVANNI, SAMUEL (PT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:DIGIOVANNI
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 1:17233 N. HOLMES BLVD STE 1650
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-2030
Mailing Address - Country:US
Mailing Address - Phone:602-547-1836
Mailing Address - Fax:602-547-2806
Practice Address - Street 1:17233 N HOLMES BLVD
Practice Address - Street 2:SUITE 1650
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-2030
Practice Address - Country:US
Practice Address - Phone:602-547-1836
Practice Address - Fax:602-547-2806
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT258262251X0800X
AZLPT-31542225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPT-31542OtherARIZONA BOARD OF PHYSICAL THERAPY