Provider Demographics
NPI:1093124257
Name:EVANS, SAMANTHA (DPT)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 SOUTHGATE COMMERCE BLVD
Mailing Address - Street 2:SUITE 38B
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-7303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3160 SOUTHGATE COMMERCE BLVD
Practice Address - Street 2:SUITE 38B
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-8549
Practice Address - Country:US
Practice Address - Phone:321-251-7877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29468225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist