Provider Demographics
NPI:1073874517
Name:PITTSFORD, SAMANTHA K (PT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:K
Last Name:PITTSFORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11675 JOLLYVILLE RD, STE 207
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4105
Mailing Address - Country:US
Mailing Address - Phone:512-856-1000
Mailing Address - Fax:512-856-4040
Practice Address - Street 1:11675 JOLLYVILLE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4105
Practice Address - Country:US
Practice Address - Phone:512-856-1000
Practice Address - Fax:512-856-4040
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1218742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX876T48OtherBCBS
TXTXB159931Medicare PIN
TX00636YMedicare PIN