Provider Demographics
NPI:1154660116
Name:SIEBERT, SAMANTHA (DPT)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:SIEBERT
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 1:2113 GOLF COURSE RD SE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1656
Mailing Address - Country:US
Mailing Address - Phone:505-898-9700
Mailing Address - Fax:505-898-8539
Practice Address - Street 1:2113 GOLF COURSE RD SE
Practice Address - Street 2:SUITE 106
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1656
Practice Address - Country:US
Practice Address - Phone:505-898-9700
Practice Address - Fax:505-898-8539
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4231225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist