Provider Demographics
NPI:1689036576
Name:COCCA, SAMANTHA CAMILLE (ATC, LMT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:CAMILLE
Last Name:COCCA
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2797 WEWATTA WAY UNIT 3037
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-3652
Mailing Address - Country:US
Mailing Address - Phone:518-810-7095
Mailing Address - Fax:
Practice Address - Street 1:2797 WEWATTA WAY UNIT 3037
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80216-3652
Practice Address - Country:US
Practice Address - Phone:518-810-7095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0026502255A2300X
GAMT010471225700000X
COMT.0023205225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer