Healthcare Provider Details

I. General information

NPI: 1861920332
Provider Name (Legal Business Name): SAMANTHA KOTZ DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA QUICK

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 WEST ST S UNIT 4
GRINNELL IA
50112-8160
US

IV. Provider business mailing address

234 WEST ST S UNIT 4
GRINNELL IA
50112-8160
US

V. Phone/Fax

Practice location:
  • Phone: 641-236-4506
  • Fax: 641-236-4316
Mailing address:
  • Phone: 641-236-4506
  • Fax: 641-236-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number087668
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: