Provider Demographics
NPI:1154590354
Name:PIZZATO, SAMANTHA (LMP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:PIZZATO
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N PINES RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4964
Mailing Address - Country:US
Mailing Address - Phone:509-925-5585
Mailing Address - Fax:509-927-7336
Practice Address - Street 1:1301 N PINES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4964
Practice Address - Country:US
Practice Address - Phone:509-925-5585
Practice Address - Fax:509-927-7336
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA540982-07225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist