Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 28016 | MD |
Y | 2251X0800X | Physical Therapist - Orthopedic | 28016 | MD |
NPI | 1053788737 |
---|---|
Provider Name | John Claude Sampson |
First Address | Frederick, MD 21702-4314 |
Second Address | Frederick, MD 21702-4314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2015 |
Last Update Date | 11/08/2020 |