Provider Demographics
NPI:1083351159
Name:SAMUEL, KATHERINE CLAIRE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:CLAIRE
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:CLAIRE
Other - Last Name:RAWLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:2607 E MISSION BLVD STE 3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5565
Practice Address - Country:US
Practice Address - Phone:479-435-9227
Practice Address - Fax:479-435-9353
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT5164225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist