Provider Demographics
NPI:1528770138
Name:STOLZENBERG, SAMARA
Entity type:Individual
Prefix:
First Name:SAMARA
Middle Name:
Last Name:STOLZENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 WAREHOUSE RD APT 90109
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3554
Mailing Address - Country:US
Mailing Address - Phone:954-864-4103
Mailing Address - Fax:
Practice Address - Street 1:8000 RED BUG LAKE RD STE 140
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9265
Practice Address - Country:US
Practice Address - Phone:407-359-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A