Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2306602749 | VA |
NPI | 1003144460 |
---|---|
Provider Name | Ms. Samantha Nichole Robert |
First Address | Norfolk, VA 23505-4117 |
Second Address | Fort Eustis, VA 23604-5548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2009 |
Last Update Date | 24/11/2009 |