Provider Demographics
NPI:1518528835
Name:SAM, EGIN (PT)
Entity type:Individual
Prefix:
First Name:EGIN
Middle Name:
Last Name:SAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 TREESTAR PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4654
Mailing Address - Country:US
Mailing Address - Phone:850-566-4803
Mailing Address - Fax:
Practice Address - Street 1:6767 LAKE WOODLANDS DR STE F
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2566
Practice Address - Country:US
Practice Address - Phone:281-364-1112
Practice Address - Fax:281-419-3101
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1217513208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation