Provider Demographics
NPI:1750807954
Name:SAMONS, STEPHANIE JEAN (PTA)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:JEAN
Last Name:SAMONS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:JEAN
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14114 ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:FL
Mailing Address - Zip Code:32565-1219
Mailing Address - Country:US
Mailing Address - Phone:850-675-8040
Mailing Address - Fax:850-675-8016
Practice Address - Street 1:14114 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:FL
Practice Address - Zip Code:32565-1219
Practice Address - Country:US
Practice Address - Phone:850-675-8040
Practice Address - Fax:850-675-8016
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26830225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant