Provider Demographics
NPI:1194134353
Name:ANDERSON, SAMANTHA RED (DOCTOR OF PHYSICAL T)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:RED
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DOCTOR OF PHYSICAL T
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LEE
Other - Last Name:RED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:400 TOWN PARK BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809
Mailing Address - Country:US
Mailing Address - Phone:706-854-9850
Mailing Address - Fax:706-854-9870
Practice Address - Street 1:400 TOWN PARK BLVD
Practice Address - Street 2:STE 100
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809
Practice Address - Country:US
Practice Address - Phone:706-854-9850
Practice Address - Fax:706-854-9870
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist