Provider Demographics
NPI:1962287177
Name:SAMSON, MONICA JOY (PTA)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:JOY
Last Name:SAMSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 SAN REMO DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8731
Mailing Address - Country:US
Mailing Address - Phone:561-236-9766
Mailing Address - Fax:
Practice Address - Street 1:187 SAN REMO DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8731
Practice Address - Country:US
Practice Address - Phone:561-236-9766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23902225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant