MEDICARE: SAMANTHA LEIGH CAGLE PT, DPT

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	188521	AK
2	225100000X	Physical Therapist	1308533	TX
3	225100000X	Physical Therapist	60892978	WA

General Provider Information

NPI Number	:	1487138723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LEIGH CAGLE PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 240302
Second Line	:
City	:	DOUGLAS
State	:	AK
Zip	:	99824-0302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 W STEVENS AVE
Second Line	:
City	:	SULTAN
State	:	WA
Zip	:	98294-9453
Country	:	US
Telephone Number	:	360-799-0958
Fax Number	:

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

Provider Enumeration Date	:	09/22/2018
Last Update Date	:	04/03/2024

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