Provider Demographics
NPI:1003564592
Name:SAMANTHA DAWSON TANDY, DPT, PLLC
Entity Type:Organization
Organization Name:SAMANTHA DAWSON TANDY, DPT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON TANDY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:574-453-8548
Mailing Address - Street 1:418 E WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-4326
Mailing Address - Country:US
Mailing Address - Phone:574-453-8548
Mailing Address - Fax:
Practice Address - Street 1:352 S DENVER ST STE 310
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3053
Practice Address - Country:US
Practice Address - Phone:574-453-8548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-14
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty