Provider Demographics
NPI:1912127937
Name:FALLON, SAMANTHA ANNA (PT)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ANNA
Last Name:FALLON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5835 POST RD
Mailing Address - Street 2:STE 112
Mailing Address - City:E GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-2154
Mailing Address - Country:US
Mailing Address - Phone:401-885-0069
Mailing Address - Fax:401-885-0071
Practice Address - Street 1:5835 POST RD
Practice Address - Street 2:STE 112
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-2154
Practice Address - Country:US
Practice Address - Phone:401-885-0051
Practice Address - Fax:401-885-0054
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist