Provider Demographics
NPI:1952023426
Name:CONWAY, SAMANTHA A (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:A
Last Name:CONWAY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:A
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4300 GOLDEN CENTER DR
Mailing Address - Street 2:STE B
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667
Mailing Address - Country:US
Mailing Address - Phone:530-344-2045
Mailing Address - Fax:530-642-0794
Practice Address - Street 1:4300 GOLDEN CENTER DR
Practice Address - Street 2:STE B
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667
Practice Address - Country:US
Practice Address - Phone:530-344-2045
Practice Address - Fax:530-642-0794
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT302690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist