Provider Demographics
NPI:1912485533
Name:HAMOUI, SAM JR (LMT)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:HAMOUI
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 W BROAD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5570
Mailing Address - Country:US
Mailing Address - Phone:610-653-7701
Mailing Address - Fax:
Practice Address - Street 1:227 W BROAD ST STE 102
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5570
Practice Address - Country:US
Practice Address - Phone:610-653-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG002793225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist