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Individual
RANJITH SAMSON
Active
Individual
RANJITH SAMSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5503012063
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5503012063
STATE LIC
MA
01
—
562460025
TAX ID
MI
01
—
650C811890
BLUE CROSS
MI
Enumeration date
05/02/2007
Last updated
01/01/2021
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