Provider Demographics
NPI:1972086288
Name:DWYER, SAMANTHA LYNN H NOGUEIRA (DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA LYNN
Middle Name:H NOGUEIRA
Last Name:DWYER
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 1:96 DOCK WATCH HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-6926
Mailing Address - Country:US
Mailing Address - Phone:908-507-8588
Mailing Address - Fax:
Practice Address - Street 1:461 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2102
Practice Address - Country:US
Practice Address - Phone:973-635-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01750400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01750400OtherPT LICENSE NUMBER