Provider Demographics
NPI:1306434063
Name:MAY, SAMANTHA N (PTA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:N
Last Name:MAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:9612 270TH ST NW STE 103
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-1911
Mailing Address - Country:US
Mailing Address - Phone:360-629-8043
Mailing Address - Fax:
Practice Address - Street 1:9612 270TH ST NW STE 103
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-1911
Practice Address - Country:US
Practice Address - Phone:425-429-8320
Practice Address - Fax:360-658-0508
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61035785225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant