Samy S Tadros, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

30815 Issued in FL

Practice address

1075 Mason Ave
Daytona Beach, FL 32117-4690

Phone

(386) 255-4596

Fax

(386) 257-0558

NPI assigned

Dec 15, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Networks

• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Good Care PT PC

  • Physical Therapy Clinic/Center
  • Staten Island, NY
  • NPI 1912277252
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1323907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1306115621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1075 MASON AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321174690",
            "telephone_number": "386-255-4596",
            "fax_number": "386-257-0558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1075 MASON AVE",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321174690",
            "telephone_number": "386-255-4596",
            "fax_number": "386-257-0558"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "575 N Williamson Blvd Apt 112",
            "address_purpose": "LOCATION",
            "city": "Daytona Beach",
            "state": "FL",
            "postal_code": "321148161",
            "country_code": "US",
            "telephone_number": "407-486-8707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TADROS",
        "first_name": "SAMY",
        "middle_name": "S",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-12-15",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305209874",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "031785",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "FL",
            "license": "PT30815",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "30815",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "019347000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mari Takeda, DMD
• Erin Taliaferro, PT, DPT
• Cemiyah Talton

• Physical Therapist in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.