Provider Demographics
NPI:1770143190
Name:CANUP, SAMANTHA COLLEEN
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:COLLEEN
Last Name:CANUP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:COLLEEN
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:615-373-7116
Practice Address - Street 1:3556 TOM AUSTIN HWY STE 2
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3960
Practice Address - Country:US
Practice Address - Phone:615-492-4595
Practice Address - Fax:615-432-4292
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist