Provider Demographics
NPI:1568902914
Name:YOUNG, SAMANTHA (LMT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 OLD CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:NEW KENT
Mailing Address - State:VA
Mailing Address - Zip Code:23124-2925
Mailing Address - Country:US
Mailing Address - Phone:804-925-5514
Mailing Address - Fax:
Practice Address - Street 1:9700 OLD CHURCH RD
Practice Address - Street 2:
Practice Address - City:NEW KENT
Practice Address - State:VA
Practice Address - Zip Code:23124-2925
Practice Address - Country:US
Practice Address - Phone:804-925-5514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019007510225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist