Provider Demographics
NPI:1013086610
Name:HAMILTON, SAMANTHA W (PT)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:W
Last Name:HAMILTON
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 1:13895 WAINWRIGHT DR.
Mailing Address - Street 2:BOISE
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713
Mailing Address - Country:US
Mailing Address - Phone:208-939-3334
Mailing Address - Fax:208-939-3341
Practice Address - Street 1:13895 WAINWRIGHT DR.
Practice Address - Street 2:BOISE
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713
Practice Address - Country:US
Practice Address - Phone:208-939-3334
Practice Address - Fax:208-939-3341
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT1450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist