Provider Demographics
NPI:1417317215
Name:SAMPSON, MAEGAN KING (PT)
Entity Type:Individual
Prefix:
First Name:MAEGAN
Middle Name:KING
Last Name:SAMPSON
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 1:1517 N HOWE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-2772
Mailing Address - Country:US
Mailing Address - Phone:910-454-0064
Mailing Address - Fax:910-454-0025
Practice Address - Street 1:1517 N HOWE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-2772
Practice Address - Country:US
Practice Address - Phone:910-454-0064
Practice Address - Fax:910-454-0025
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP16121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist