Provider Demographics
NPI:1699032912
Name:SCHUKNECHT, SAMANTHA JO (DPT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:SCHUKNECHT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:JO
Other - Last Name:GABARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:29255 NORTHWESTERN HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5742
Mailing Address - Country:US
Mailing Address - Phone:248-353-1234
Mailing Address - Fax:248-353-1211
Practice Address - Street 1:3435 LIVERNOIS RD # 1A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-5063
Practice Address - Country:US
Practice Address - Phone:248-353-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0008822255A2300X
MI5501018059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer