Provider Demographics
NPI:1336455906
Name:HERRICK, SAMANTHA L (DPT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:HERRICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:L
Other - Last Name:HOVING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3903 NORTHDALE BLVD
Mailing Address - Street 2:STE 111W
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1864
Mailing Address - Country:US
Mailing Address - Phone:813-381-6778
Mailing Address - Fax:440-815-2120
Practice Address - Street 1:21756 STATE ROAD 54
Practice Address - Street 2:STE 102
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-2905
Practice Address - Country:US
Practice Address - Phone:813-279-6234
Practice Address - Fax:813-949-1927
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-018063225100000X
FLPT29019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist