Provider Demographics
NPI:1003631151
Name:SAMSON, KARIS (LMT)
Entity type:Individual
Prefix:MS
First Name:KARIS
Middle Name:
Last Name:SAMSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W SIMPSON ST APT 4
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-1687
Mailing Address - Country:US
Mailing Address - Phone:734-276-0898
Mailing Address - Fax:
Practice Address - Street 1:630 COFFMAN ST STE B
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-8303
Practice Address - Country:US
Practice Address - Phone:303-652-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0016373225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist