Provider Demographics
NPI:1366739583
Name:DAVIS, SAMANTHA E (PT, DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:E
Last Name:DAVIS
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:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:4020 RAINTREE RD STE D
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-3749
Practice Address - Country:US
Practice Address - Phone:757-484-4241
Practice Address - Fax:757-484-4487
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206992225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01127679OtherMEDICARE RAILROAD
VA9054750OtherAETNA
VA1366739583Medicaid
VA192931OtherBCBS (PHYSICAL THERAPY)
VA192931OtherBCBS (PHYSICAL THERAPY)
VAQ36731AMedicare PIN