Provider Demographics
NPI:1447752258
Name:MULVANEY, SAMANTHA KATHLEEN (CPTA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KATHLEEN
Last Name:MULVANEY
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1503 WASHINGTON LN
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:KS
Mailing Address - Zip Code:67010-1638
Mailing Address - Country:US
Mailing Address - Phone:316-775-0700
Mailing Address - Fax:316-775-0730
Practice Address - Street 1:418 N ANDOVER RD STE 400
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-9533
Practice Address - Country:US
Practice Address - Phone:316-733-0077
Practice Address - Fax:316-733-9007
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1403251225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant