Provider Demographics
NPI:1598522609
Name:THORMAN, SAMANTHA LEE (PTA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEE
Last Name:THORMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 THOUSAND OAKS DR APT 819
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2378
Mailing Address - Country:US
Mailing Address - Phone:956-244-5228
Mailing Address - Fax:
Practice Address - Street 1:400 CONCORD PLAZA DR STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6991
Practice Address - Country:US
Practice Address - Phone:210-804-5911
Practice Address - Fax:210-582-2692
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2162450225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant