Provider Demographics
NPI:1922299619
Name:CABRERA, SAMANTHA ALEXIS (PT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ALEXIS
Last Name:CABRERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 BRIGHTON 11TH ST.
Mailing Address - Street 2:1ST FLR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5327
Mailing Address - Country:US
Mailing Address - Phone:718-891-8826
Mailing Address - Fax:
Practice Address - Street 1:164 BRIGHTON 11TH ST
Practice Address - Street 2:1ST FLR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5327
Practice Address - Country:US
Practice Address - Phone:718-891-8826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019519174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist