Provider Demographics
NPI:1790318517
Name:KEIFER, SAMANTHA ROSE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:ROSE
Last Name:KEIFER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-8825
Mailing Address - Country:US
Mailing Address - Phone:570-617-0399
Mailing Address - Fax:
Practice Address - Street 1:903 VALLEY RD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-8825
Practice Address - Country:US
Practice Address - Phone:570-617-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT027496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist