Provider Demographics
NPI:1760746861
Name:STRONG, SAMANTHA EZ (PT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:EZ
Last Name:STRONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:EZ
Other - Last Name:BELLAVANCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:8 S COMMONS RD
Mailing Address - Street 2:UNIT 10B
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-1035
Mailing Address - Country:US
Mailing Address - Phone:203-759-1229
Mailing Address - Fax:
Practice Address - Street 1:8 S COMMONS RD
Practice Address - Street 2:UNIT 10B
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-1035
Practice Address - Country:US
Practice Address - Phone:203-759-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14.009428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist