Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT0010931 | FL |
NPI | 1205015419 |
---|---|
Provider Name | Samson Victor Chiang |
First Address | Pinellas Park, FL 33780-0236 |
Second Address | Pinellas Park, FL 33782-2336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2007 |
Last Update Date | 08/03/2019 |