Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1911 | NV |
N | 2251C2600X | Cardiopulmonary | 1911 | NV |
NPI | 1568524692 |
---|---|
Provider Name | Karl John Samonte |
First Address | Las Vegas, NV 89117-2749 |
Second Address | Las Vegas, NV 89119-8204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1911 | PHYSICAL THERAPY (01) | NV |