Provider Demographics
NPI:1588967632
Name:HARTE, SAMANTHA BLAKE (DPT)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:BLAKE
Last Name:HARTE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 315
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401
Mailing Address - Country:US
Mailing Address - Phone:310-434-2400
Mailing Address - Fax:310-434-2424
Practice Address - Street 1:900 WILSHIRE BLVD
Practice Address - Street 2:SUITE 315
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401
Practice Address - Country:US
Practice Address - Phone:310-434-2400
Practice Address - Fax:310-434-2424
Is Sole Proprietor?:No
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14736Medicare PIN