Provider Demographics
NPI:1588040620
Name:STEARNS, SAMANTHA CAROLYN (PTA)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:CAROLYN
Last Name:STEARNS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21300 NAUTIQUE BLVD
Mailing Address - Street 2:APT #303
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-6414
Mailing Address - Country:US
Mailing Address - Phone:704-236-4200
Mailing Address - Fax:
Practice Address - Street 1:514 WILLIAMSON RD STE 431
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9227
Practice Address - Country:US
Practice Address - Phone:704-360-2595
Practice Address - Fax:704-360-2596
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA5717225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant