Active NPI
Richard D Samson, PT
- Physical Therapist
- Modesto, CA
National Provider Identifier
1770812042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT28179
- Practice address
- 4601 Dale Rd
Modesto, CA 95356-9718 - Phone
- (209) 735-5000
- NPI assigned
- Dec 16, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT28179 | CA | Primary |
Addresses
Primary practice location
4601 Dale Rd
Modesto, CA 95356-9718
Mailing address
10854 Flaming Star LN
Stockton, CA 95209-4260
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT28179 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1260921600000",
"number": "1770812042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10854 FLAMING STAR LN",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952094260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4601 DALE RD",
"city": "MODESTO",
"state": "CA",
"postal_code": "953569718",
"telephone_number": "209-735-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMSON",
"first_name": "RICHARD",
"middle_name": "D",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-12-16",
"last_updated": "2009-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT28179",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.