MEDICARE: DR. SAMANTHA AUDREY RICHARDS PT, DPT, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	307038	CA

General Provider Information

NPI Number	:	1073320826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMANTHA AUDREY RICHARDS PT, DPT, MS

Provider Business Mailing Address
First Line	:	415 W TAFT AVE STE E
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92865-4249
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 W TAFT AVE STE E
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92865-4249
Country	:	US
Telephone Number	:	714-939-6200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	12/19/2024

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