Provider Demographics
NPI:1396403895
Name:MEADE, SAMANTHA D (DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:D
Last Name:MEADE
Suffix:
Gender:F
Credentials:DPT
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15410 S MOUNTAIN PKWY STE 112
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-6691
Mailing Address - Country:US
Mailing Address - Phone:480-706-1161
Mailing Address - Fax:
Practice Address - Street 1:3850 W HAPPY VALLEY RD STE 147-149
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-3280
Practice Address - Country:US
Practice Address - Phone:623-322-8925
Practice Address - Fax:623-444-8336
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2024-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ31968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist