Provider Demographics
NPI:1013474972
Name:DWORKIN, SAMANTHA (ATC,LAT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DWORKIN
Suffix:
Gender:F
Credentials:ATC,LAT
Other - Prefix:
Other - First Name:SAMI
Other - Middle Name:
Other - Last Name:DWORKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC,LAT
Mailing Address - Street 1:5956 KING WILLIAM DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4356
Mailing Address - Country:US
Mailing Address - Phone:972-971-6997
Mailing Address - Fax:
Practice Address - Street 1:6600 STADIUM DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-2210
Practice Address - Country:US
Practice Address - Phone:972-971-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT74602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer