Provider Demographics
NPI:1538806757
Name:LOZANO-GRAHAM, SAMPAGUITA (PT)
Entity type:Individual
Prefix:
First Name:SAMPAGUITA
Middle Name:
Last Name:LOZANO-GRAHAM
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 1:18738 RYAN CT
Mailing Address - Street 2:
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-9434
Mailing Address - Country:US
Mailing Address - Phone:302-236-9545
Mailing Address - Fax:
Practice Address - Street 1:699 BETHANY LOOP UNIT 3
Practice Address - Street 2:
Practice Address - City:BETHANY BEACH
Practice Address - State:DE
Practice Address - Zip Code:19930-9035
Practice Address - Country:US
Practice Address - Phone:302-616-3651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist