Provider Demographics
NPI:1528597135
Name:KLEIN, SAMANTHA ROSE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ROSE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S FRONTAGE RD STE D
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5271
Mailing Address - Country:US
Mailing Address - Phone:601-456-0159
Mailing Address - Fax:601-863-8505
Practice Address - Street 1:2222 S FRONTAGE RD STE D
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5271
Practice Address - Country:US
Practice Address - Phone:601-456-0159
Practice Address - Fax:601-863-8505
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist