Provider Demographics
NPI:1619042900
Name:SAMARA, LORRAINE A (RPT)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:A
Last Name:SAMARA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 EAST WELLING AVENUE
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534
Mailing Address - Country:US
Mailing Address - Phone:609-737-7769
Mailing Address - Fax:
Practice Address - Street 1:330 NORTH HARRISON STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-924-0697
Practice Address - Fax:609-924-8706
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PS10974OtherOXFORD
PS10974OtherOXFORD