Provider Demographics
NPI:1053867325
Name:BLAY, SAMANTHA HALE (PTA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:HALE
Last Name:BLAY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JO
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:2750 CHAPEL HILL RD
Practice Address - Street 2:STE 1200
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1721
Practice Address - Country:US
Practice Address - Phone:678-981-6290
Practice Address - Fax:678-981-6291
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003648225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant