Provider Demographics
NPI:1780714717
Name:CARLSEN, SAMANTHA (PT)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:CARLSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18323 BOTHELL EVERETT HWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5246
Mailing Address - Country:US
Mailing Address - Phone:425-806-5700
Mailing Address - Fax:425-806-5701
Practice Address - Street 1:3726 BROADWAY
Practice Address - Street 2:SUITE 104
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-5030
Practice Address - Country:US
Practice Address - Phone:425-252-4600
Practice Address - Fax:425-252-4477
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8468167Medicaid
WA8468167Medicaid