Provider Demographics
NPI:1992381321
Name:CREAGER, SAMANTHA DORA (PTA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:DORA
Last Name:CREAGER
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 1:51 CAMBRIDGE TRCE
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-2471
Mailing Address - Country:US
Mailing Address - Phone:937-620-7931
Mailing Address - Fax:
Practice Address - Street 1:5535 S WILLIAMSON BLVD STE 700
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-8321
Practice Address - Country:US
Practice Address - Phone:386-231-6327
Practice Address - Fax:386-767-7281
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL306562081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine