Provider Demographics
NPI:1578573135
Name:SAMUELS, VICKIE FAYE (PT)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:FAYE
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:FAYE
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3 TREE TOP DR
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-3039
Mailing Address - Country:US
Mailing Address - Phone:828-274-2188
Mailing Address - Fax:828-274-7843
Practice Address - Street 1:23 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3152
Practice Address - Country:US
Practice Address - Phone:828-274-2188
Practice Address - Fax:828-274-7843
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4505225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic