Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 040609 | NY |
N | 225100000X | Physical Therapist | PTL.0015509 | CO |
N | 2251P0200X | Physical Therapist - Pediatrics | PTL.0015509 | CO |
NPI | 1063968667 |
---|---|
Provider Name | Samantha Sawade |
First Address | New York, NY 10021-4823 |
Second Address | New York, NY 10021-4823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 09/04/2021 |