Provider Demographics
NPI:1588132799
Name:HERBSTER, SAMANTHA JANE (DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:HERBSTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 WEBSTER PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2832
Mailing Address - Country:US
Mailing Address - Phone:531-333-2613
Mailing Address - Fax:
Practice Address - Street 1:10824 OLD MILL RD STE 10-6
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2642
Practice Address - Country:US
Practice Address - Phone:531-333-2613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3636225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist