Provider Demographics
NPI:1225503949
Name:BRODIE, SAMANTHA MCLEAN (DPT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MCLEAN
Last Name:BRODIE
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 1:313 ESPLANADE PL
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2005
Mailing Address - Country:US
Mailing Address - Phone:503-791-3037
Mailing Address - Fax:
Practice Address - Street 1:5580 DANIEL SMITH RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1104
Practice Address - Country:US
Practice Address - Phone:757-499-7029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist