Provider Demographics
NPI:1164598132
Name:NAVARRO, SAMANTHA WHITE (PT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:WHITE
Last Name:NAVARRO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 SEAGULL ST NE
Mailing Address - Street 2:SUITE B-102
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2500
Mailing Address - Country:US
Mailing Address - Phone:505-823-2411
Mailing Address - Fax:505-858-0650
Practice Address - Street 1:6100 SEAGULL ST NE
Practice Address - Street 2:SUITE B-102
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2500
Practice Address - Country:US
Practice Address - Phone:505-823-2411
Practice Address - Fax:505-858-0650
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM695957OtherACN
NM26790OtherPRESBYTERIAN HEALTH PLAN
NMNM00Q490OtherBCBS