Basic Information
| Provider Information | |||||||||
| NPI: | 1679566632 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAMS | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT, DPT, OCS, SCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17325 BELL NORTH DR | ||||||||
| Address2: | |||||||||
| City: | SCHERTZ | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781543368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885904002 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 184 CREEKSIDE PARK RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | SPRING BRANCH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780706240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8309804565 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 1126878 | TX | N | Other Service Providers | Specialist | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 195417401 | 05 | TX | MEDICAID |