Healthcare Provider Details

I. General information

NPI: 1396064861
Provider Name (Legal Business Name): KATHERINE SAMWORTH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 NEW LINDEN HILL RD RED CLAY CONSOLIDATED SCHOOL DISTRICT
WILMINGTON DE
19808-2930
US

IV. Provider business mailing address

4550 NEW LINDEN HILL ROAD RED CLAY CONSOLIDATED SCHOOL DISTRICT
WILMINGTON DE
19808-2930
US

V. Phone/Fax

Practice location:
  • Phone: 302-552-3797
  • Fax:
Mailing address:
  • Phone: 302-552-3797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0000348
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: