Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 8092 | AZ |
NPI | 1275584567 |
---|---|
Provider Name | Justin M Sampley |
First Address | Phoenix, AZ 85024-5657 |
Second Address | Phoenix, AZ 85024-5657 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 15/11/2016 |