Provider Demographics
NPI:1407100746
Name:LINVILLE, SAMANTHA LEE (PT, DPT, SCS)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEE
Last Name:LINVILLE
Suffix:
Gender:F
Credentials:PT, DPT, SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 SE CENTURY DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-3286
Mailing Address - Country:US
Mailing Address - Phone:816-524-1442
Mailing Address - Fax:816-524-1442
Practice Address - Street 1:1254 SE CENTURY DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-3286
Practice Address - Country:US
Practice Address - Phone:816-524-1442
Practice Address - Fax:816-524-1442
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-04200225100000X
MO2018032325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA2765007OtherMEDICARE
MOMA5234005OtherMEDICARE
MOMA1102024OtherMEDICARE