Provider Demographics
NPI:1902374291
Name:SELVAGE, SAMANTHA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SELVAGE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:KLOTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5102 CRYORS LN
Mailing Address - Street 2:
Mailing Address - City:MC KENNEY
Mailing Address - State:VA
Mailing Address - Zip Code:23872-3212
Mailing Address - Country:US
Mailing Address - Phone:540-446-4518
Mailing Address - Fax:
Practice Address - Street 1:5102 CRYORS LN
Practice Address - Street 2:
Practice Address - City:MC KENNEY
Practice Address - State:VA
Practice Address - Zip Code:23872-3212
Practice Address - Country:US
Practice Address - Phone:540-446-4518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist