Provider Demographics
NPI:1811169626
Name:LEVINSON, SAMANTHA BETH (DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:BETH
Last Name:LEVINSON
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 1:22912 VIA GENOA
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3416
Mailing Address - Country:US
Mailing Address - Phone:949-350-7265
Mailing Address - Fax:
Practice Address - Street 1:22912 VIA GENOA
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3416
Practice Address - Country:US
Practice Address - Phone:949-350-7265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23779225100000X
AZ7982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist