Healthcare Provider Details

I. General information

NPI: 1336455906
Provider Name (Legal Business Name): SAMANTHA L HERRICK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA L HOVING DPT

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 05/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21756 STATE ROAD 54 STE 102
LUTZ FL
33549-2905
US

IV. Provider business mailing address

3903 NORTHDALE BLVD STE 111W
TAMPA FL
33624-1864
US

V. Phone/Fax

Practice location:
  • Phone: 813-279-6234
  • Fax: 813-949-1927
Mailing address:
  • Phone: 813-381-6778
  • Fax: 440-815-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-018063
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29019
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: