Provider Demographics
NPI:1083015473
Name:PERDUE, SAMANTHA ROSSI (DPT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ROSSI
Last Name:PERDUE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:E
Other - Last Name:ROSSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1535 BURNSIDE PL
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8813
Mailing Address - Country:US
Mailing Address - Phone:412-980-7337
Mailing Address - Fax:
Practice Address - Street 1:7940 29TH AVE NE STE 101
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-7179
Practice Address - Country:US
Practice Address - Phone:360-870-2473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0014545225100000X, 225100000X
WAPT61418800225100000X
PAPT023772225100000X, 225100000X
MAPT22865225100000X
TX1256481225100000X
MIPT5501017643225100000X
ORPT61088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist