Provider Demographics
NPI:1508986928
Name:GORRELL, SAMANTHA MARIA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIA
Last Name:GORRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:MARIA
Other - Last Name:MATTOCCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1311 MAMARONECK AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-5224
Mailing Address - Country:US
Mailing Address - Phone:914-777-8705
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:1915 GUERNSEY AVE
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3701
Practice Address - Country:US
Practice Address - Phone:215-659-8600
Practice Address - Fax:215-659-4498
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01899700225100000X
PAPT225100000X
PAPT016903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist