Healthcare Provider Details

I. General information

NPI: 1619704665
Provider Name (Legal Business Name): SAMANTHA E BROWN PTA, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 09/16/2024
Certification Date: 09/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 LAGAE RD STE E&F
CASTLE PINES CO
80108-9452
US

IV. Provider business mailing address

194 VISTA CLIFF CIR
CASTLE ROCK CO
80104-5526
US

V. Phone/Fax

Practice location:
  • Phone: 720-523-8460
  • Fax:
Mailing address:
  • Phone: 303-859-9109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA33048
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA14639
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: