Individual
MS. SAMANTHA DEPAULO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
154 EDGEGROVE AVE, STATEN ISLAND, NY 10312-3333
(718) 356-4868
Mailing address
154 EDGEGROVE AVE, STATEN ISLAND, NY 10312-3333
(718) 356-4868
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00286700
NJ
Other
Enumeration date
04/23/2012
Last updated
04/23/2012
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