Provider Demographics
NPI:1467874610
Name:PETERS, SAMANTHA (LMT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:114 1ST AVE S STE 160
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4180
Mailing Address - Country:US
Mailing Address - Phone:714-292-5800
Mailing Address - Fax:
Practice Address - Street 1:114 1ST AVE S STE 160
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4180
Practice Address - Country:US
Practice Address - Phone:714-292-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006686225700000X
ND24102225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist