Provider Demographics
NPI:1184748048
Name:TUMASANG, SAMIAT BISOLA (DPT)
Entity type:Individual
Prefix:
First Name:SAMIAT
Middle Name:BISOLA
Last Name:TUMASANG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SAMIAT
Other - Middle Name:BISOLA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2127 BRIGADE CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-2514
Mailing Address - Country:US
Mailing Address - Phone:757-218-9831
Mailing Address - Fax:
Practice Address - Street 1:2127 BRIGADE CIR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-2514
Practice Address - Country:US
Practice Address - Phone:757-218-9831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052048242251G0304X
MD24046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics