Provider Demographics
NPI:1538487194
Name:SMITH, SAMANTHA LAKEY (DPT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LAKEY
Last Name:SMITH
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 1:1812 N MIDLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-1747
Mailing Address - Country:US
Mailing Address - Phone:208-442-2525
Mailing Address - Fax:208-442-2505
Practice Address - Street 1:1812 N MIDLAND BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1747
Practice Address - Country:US
Practice Address - Phone:208-442-2525
Practice Address - Fax:208-442-2505
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-18972251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics