Ebony Samuels

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A5202 Issued in MD

Practice address

18109 Prince Philip Dr Ste B200
Olney, MD 20832-1591

Phone

(301) 570-7415

NPI assigned

Oct 22, 2018

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1540166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565568000000",
    "number": "1871069419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12146 POND PINE DR",
            "city": "CLARKSBURG",
            "state": "MD",
            "postal_code": "208714475",
            "telephone_number": "352-942-5151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18109 PRINCE PHILIP DR STE B200",
            "city": "OLNEY",
            "state": "MD",
            "postal_code": "208321591",
            "telephone_number": "301-570-7415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUELS",
        "first_name": "EBONY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-22",
        "last_updated": "2019-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MD",
            "license": "A5202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Elizabeth Ruiz, OTR/L
• Mary Kathleen Ryner, CCC-SLP
• Mohammad Ahmad Safdar Ali, MB, BS
• Safe Harbor Christian Counseling DC Metro
• Mitra Salim, RPH
• Christian Bernard E San Jose, PT
• Cressida Rivadelo San Jose
• Roger Kenneth Sandberg, LCPC
• Compton Saul
• Jennifer Sax, CCC-SLP

• Physical Therapy Assistant in Olney, MD
• Providers in Olney, MD by specialty
• Physical Therapy Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; 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.