Healthcare Provider Details

I. General information

NPI: 1255246088
Provider Name (Legal Business Name): SAMANTHA KANE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 11TH AVE
DE WITT IA
52742-1025
US

IV. Provider business mailing address

1108 11TH AVE
DE WITT IA
52742-1025
US

V. Phone/Fax

Practice location:
  • Phone: 563-293-1655
  • Fax: 563-205-5393
Mailing address:
  • Phone: 563-293-1655
  • Fax: 563-205-5393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number137933
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: