Individual
JONATHAN LEE SAMUELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
162 LEGACY OAKS DR, SUITE 2102, KNIGHTDALE, NC 27545-6556
(919) 373-1799
Mailing address
5213 S ALSTON AVE, DURHAM, NC 27713-4430
(919) 620-4917
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
16003
NC
Other
Enumeration date
12/16/2015
Last updated
12/16/2015
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