Provider Demographics
NPI:1366936338
Name:GUSMAN, SAMANTHA (PT DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:GUSMAN
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12585 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-6216
Mailing Address - Country:US
Mailing Address - Phone:786-290-2041
Mailing Address - Fax:
Practice Address - Street 1:4800 LINTON BLVD STE F116
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6583
Practice Address - Country:US
Practice Address - Phone:561-498-1423
Practice Address - Fax:561-883-6161
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-21
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33620225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT33620OtherPHYSICAL THERAPIST LICENSE