Provider Demographics
NPI:1033375860
Name:TAYLOR, SAMANTHA K (DPT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:K
Last Name:TAYLOR
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 1:984B LASKIN RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-3905
Mailing Address - Country:US
Mailing Address - Phone:757-395-6900
Mailing Address - Fax:757-425-7180
Practice Address - Street 1:984B LASKIN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-3905
Practice Address - Country:US
Practice Address - Phone:757-395-6900
Practice Address - Fax:757-425-7180
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192971OtherBCBS PHYSICAL THERAPY
VA1033375860Medicaid
VA9720186OtherAETNA
VAP00637364OtherRAILROAD MEDICARE
VA1033375860Medicaid
VAC05954Medicare PIN