Provider Demographics
NPI:1306730536
Name:ANDERSON, SAMANTHA KASEY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:KASEY
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 WHITAKER RD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27011-9208
Mailing Address - Country:US
Mailing Address - Phone:336-466-5588
Mailing Address - Fax:
Practice Address - Street 1:865 WESTLAKE DR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2102
Practice Address - Country:US
Practice Address - Phone:336-719-6165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP24121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist