Provider Demographics
NPI:1154677912
Name:CHARTERS, SAMANTHA M (ATC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:M
Last Name:CHARTERS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 TALILUNA AVE
Mailing Address - Street 2:APT 227
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7813
Mailing Address - Country:US
Mailing Address - Phone:757-374-0279
Mailing Address - Fax:
Practice Address - Street 1:901 S NATIONAL AVE
Practice Address - Street 2:ATHLETIC MEDICAL AND REHAB
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65897
Practice Address - Country:US
Practice Address - Phone:417-836-5461
Practice Address - Fax:417-836-6101
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN313005174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist