Provider Demographics
NPI:1104151687
Name:SAMHOURY, SUMER (MSPT, DPT, PRPC, WCS)
Entity type:Individual
Prefix:
First Name:SUMER
Middle Name:
Last Name:SAMHOURY
Suffix:
Gender:F
Credentials:MSPT, DPT, PRPC, WCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18382 AYLESBURY LN
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-8161
Mailing Address - Country:US
Mailing Address - Phone:917-450-4854
Mailing Address - Fax:
Practice Address - Street 1:609 S ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4123
Practice Address - Country:US
Practice Address - Phone:813-742-5986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32980261QP2000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107807000Medicaid
FLY911WOtherBLUE CROSS BLUE SHIELD
FLY911WOtherBLUE CROSS BLUE SHIELD