Provider Demographics
NPI:1104157783
Name:FRIEDEMAN, SAMANTHA LYN (MSPT)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LYN
Last Name:FRIEDEMAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 E SHENENDOAH RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-9031
Mailing Address - Country:US
Mailing Address - Phone:732-938-3177
Mailing Address - Fax:
Practice Address - Street 1:500 RIVER AVE
Practice Address - Street 2:SUITE 245
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4738
Practice Address - Country:US
Practice Address - Phone:732-367-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPT40QA00726700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist