Provider Demographics
NPI:1932946324
Name:GARBAZIO, SAMANTHA R
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:R
Last Name:GARBAZIO
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 1:13207 WHISPERING PALMS PL SW APT 701
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-2506
Mailing Address - Country:US
Mailing Address - Phone:317-331-3782
Mailing Address - Fax:
Practice Address - Street 1:6250 PARK BLVD N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-3237
Practice Address - Country:US
Practice Address - Phone:727-541-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA98777225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist