Provider Demographics
NPI:1821818543
Name:CRITTENDEN, SAMANTHA M (DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:M
Last Name:CRITTENDEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:860 OMNI BLVD STE 128
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4483
Mailing Address - Country:US
Mailing Address - Phone:572-328-8607
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:5424 DISCOVERY PARK BLVD
Practice Address - Street 2:BUILDING B, SUITE 101
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188
Practice Address - Country:US
Practice Address - Phone:757-345-2512
Practice Address - Fax:757-345-0859
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-11-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA2305216808225100000X
VA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist