Provider Demographics
NPI:1306918479
Name:SAMPSON, TERESA NOELLE (PT)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:NOELLE
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:512 3RD ST NE
Practice Address - Street 2:
Practice Address - City:HARTLEY
Practice Address - State:IA
Practice Address - Zip Code:51346-1204
Practice Address - Country:US
Practice Address - Phone:712-728-2702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0803635Medicaid
IA0601260Medicaid
IA0655407Medicaid
IA16Z381Medicare Oscar/Certification
IA160126Medicare Oscar/Certification
IA0601260Medicaid
IA16U126Medicare Oscar/Certification
IA0803635Medicaid