Ethan Sam, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

8233885-2401 Issued in UT

Practice address

9844 S 1300 E Ste 200
Sandy, UT 84094-4689

Phone

(801) 571-0099

NPI assigned

Aug 17, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Registered Physical Therapists IncGroup PAC ID 9537151733, 64 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Registered Physical Therapists LLC

  • Physical Therapy Clinic/Center
  • Sandy, UT
  • NPI 1477582633
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1692230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1487437901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9844 S 1300 E STE 300",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840944693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9844 S 1300 E STE 200",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840944689",
            "telephone_number": "801-571-0099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAM",
        "first_name": "ETHAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-17",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "8233885-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jazmin Ivette Salinas
• Renee Elizabeth Salois, OTD, OTR/L
• Salt Lake Nutricoaching LLC
• Salt Lake Women'S Center
• Salt Psychological and Behavioral Services
• Lisa Samuelu
• Niloufar Sanatinia
• Seema Sandhu, MD
• Diane Louise Sandoval, LCSW
• Kim Dawn Sandrock, RN

• Physical Therapist in Sandy, UT
• Providers in Sandy, UT by specialty
• Physical Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; 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.