Provider Demographics
NPI:1255923355
Name:NILA, SAMANTHA E (LAT)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:E
Last Name:NILA
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18922 MOUNTAIN SPRING DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-5518
Mailing Address - Country:US
Mailing Address - Phone:832-256-2602
Mailing Address - Fax:
Practice Address - Street 1:18922 MOUNTAIN SPRING DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-5518
Practice Address - Country:US
Practice Address - Phone:832-256-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLAT25492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer