Provider Demographics
NPI:1043950306
Name:MCBAY, SAMANTHA (LMT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MCBAY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14908 WATERFORD CHASE PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6639
Mailing Address - Country:US
Mailing Address - Phone:321-367-9188
Mailing Address - Fax:
Practice Address - Street 1:14908 WATERFORD CHASE PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6639
Practice Address - Country:US
Practice Address - Phone:321-367-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA98158225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty