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NPI Code Detail

MEDICARE: SAMANTHA EMMERT

MEDICARE:   SAMANTHA  EMMERT
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
1225100000XPhysical Therapist046986NY

General Provider Information

NPI Number : 1104401504
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA EMMERT
Provider Business Mailing Address
First Line : 16 MAYBROOK RD STE A
Second Line :
City : CAMPBELL HALL
State : NY
Zip : 10916-2741
Country : US
Telephone Number : 845-636-4344
Fax Number : 845-636-4355
Provider Business Practice Location Address
First Line : 1450 ROUTE 208
Second Line :
City : WALLKILL
State : NY
Zip : 12589-3799
Country : US
Telephone Number : 845-895-1115
Fax Number : 845-414-6950
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2021
Last Update Date : 03/17/2021

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Directions to “ SAMANTHA EMMERT ” Practice Location

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