Provider Demographics
NPI:1669740742
Name:BECKTON, SAMANTHA (PTA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BECKTON
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 1:20 CLEMENT DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1135
Mailing Address - Country:US
Mailing Address - Phone:828-273-9528
Mailing Address - Fax:
Practice Address - Street 1:4687 BOYLSTON HWY
Practice Address - Street 2:
Practice Address - City:MILLS RIVER
Practice Address - State:NC
Practice Address - Zip Code:28759-6731
Practice Address - Country:US
Practice Address - Phone:828-890-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4568225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant