Provider Demographics
NPI:1427305655
Name:PERRY, SAMANTHA MARIE (MS, ATC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 W CERES CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8589
Mailing Address - Country:US
Mailing Address - Phone:559-936-0573
Mailing Address - Fax:
Practice Address - Street 1:805 W ACEQUIA AVE STE 1C
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6163
Practice Address - Country:US
Practice Address - Phone:559-625-3838
Practice Address - Fax:559-625-1309
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374700000X
SD20000118452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No374700000XNursing Service Related ProvidersTechnician