Provider Demographics
NPI:1871748822
Name:SAMUEL, EMAD LIBIB (RPT)
Entity type:Individual
Prefix:
First Name:EMAD
Middle Name:LIBIB
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16621 CAROUSEL LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2117
Mailing Address - Country:US
Mailing Address - Phone:714-642-6754
Mailing Address - Fax:714-840-6403
Practice Address - Street 1:16621 CAROUSEL LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-2117
Practice Address - Country:US
Practice Address - Phone:714-642-6754
Practice Address - Fax:714-840-6403
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist