Provider Demographics
NPI:1275806374
Name:HART, SAMANTHA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 RUSTIC TIMBERS LN
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1433
Mailing Address - Country:US
Mailing Address - Phone:972-998-2123
Mailing Address - Fax:
Practice Address - Street 1:4951 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2707
Practice Address - Country:US
Practice Address - Phone:972-410-5777
Practice Address - Fax:972-410-5778
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-21
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12148752251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic