Corey Samudosky, PT, DPT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

1373953 Issued in TX

Practice address

609 Medical Center Dr BLDG 200
Decatur, TX 76234-3866

Phone

(940) 626-1360

NPI assigned

Jan 11, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bonnette Elite Physical Therapy and WellnessGroup PAC ID 1759671399, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Bonnette Elite Physical Therapy and Wellness

  • Physical Therapy Clinic/Center
  • Fort Worth, TX
  • NPI 1891141362

  Sports

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1704931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709164800000",
    "number": "1386415172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2951 PICADILLY LN APT 826",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762072084",
            "telephone_number": "412-651-4379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 MEDICAL CENTER DR BLDG 200",
            "city": "DECATUR",
            "state": "TX",
            "postal_code": "762343866",
            "telephone_number": "940-626-1360"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6930 Harris Pkwy Ste 120",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761324272",
            "country_code": "US",
            "telephone_number": "817-885-0668",
            "fax_number": "817-887-5875",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUDOSKY",
        "first_name": "COREY",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-11",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "TX",
            "license": "1373953",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "TX",
            "license": "1373953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• S & S Innovations, LLC
• Sabra Services LLC
• Sage Alignment LLC
• Dania Salam-King, BCBA
• Raja Salfiti
• Sarah Sinclair Sanders
• Zan Sattar, DMD
• Mason Savage, LPTA
• Linda Marie Schaefer, PA
• Louise Marcia Scudieri, CRNA, MS

• Orthopedic Physical Therapist in Decatur, TX
• Providers in Decatur, TX by specialty
• Orthopedic Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.