Provider Demographics
NPI:1831461144
Name:SAMS, SABRINA L (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SABRINA
Middle Name:L
Last Name:SAMS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050B VILLAGE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9499
Mailing Address - Country:US
Mailing Address - Phone:270-443-0681
Mailing Address - Fax:270-442-7948
Practice Address - Street 1:5050B VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9499
Practice Address - Country:US
Practice Address - Phone:270-443-0681
Practice Address - Fax:270-442-7948
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02842225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant