Provider Demographics
NPI:1760858088
Name:HVASTA, SAMANTHA NICOLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:NICOLE
Last Name:HVASTA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:NICOLE
Other - Last Name:SUNDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:240 S WHITE HORSE PIKE STE C-6
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1156
Mailing Address - Country:US
Mailing Address - Phone:609-561-2994
Mailing Address - Fax:609-561-2994
Practice Address - Street 1:240 S WHITE HORSE PIKE STE C-6
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1156
Practice Address - Country:US
Practice Address - Phone:609-561-5308
Practice Address - Fax:609-561-2994
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01619400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist