| Doctor Name: | MR. JEREMIAH YANGA SAMSON |
| NPI Number: | 1083692370 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PT, MSPT, OCS, COMT |
| License Number: | 34537 |
| Business Practice Address: | 2200 Bergquist Dr Attn: Credentials (cmc) Lackland A F B, TX - 782369908 |
| Business Phone Number: | 2102920920 |
| Business Fax Number: | |
| Mailing Address: | 513 Brix Marina Ct, FAIRFIELD |
| State: | CA |
| Postal Code: | 94534 |
| Phone Number: | 7077041554 |
| Fax Number: | |
| NPI Enumeration Date: | 01/06/2006 |
| NPI Last Update Date: | 03/25/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251X0800X |
| License Number: | 34537 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Orthopedic |
| Taxonomy Definition: | |