Provider Demographics
NPI:1952769812
Name:KLINE, SAMANTHA CORREIA (DPT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:CORREIA
Last Name:KLINE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:CORREIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2505 RACQUET LN
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-6114
Mailing Address - Country:US
Mailing Address - Phone:509-453-7325
Mailing Address - Fax:509-453-7330
Practice Address - Street 1:2505 RACQUET LN
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6114
Practice Address - Country:US
Practice Address - Phone:509-453-7325
Practice Address - Fax:509-453-7330
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13804225100000X
WAPT61169792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist