Provider Demographics
NPI:1174349021
Name:ALON, SAMUEL EDWARD (DPT)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:EDWARD
Last Name:ALON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23050 CUMORAH CREST DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-3743
Mailing Address - Country:US
Mailing Address - Phone:818-620-8013
Mailing Address - Fax:
Practice Address - Street 1:23050 CUMORAH CREST DR
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-3743
Practice Address - Country:US
Practice Address - Phone:818-620-8013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307080225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist