Healthcare Provider Details

I. General information

NPI: 1285691600
Provider Name (Legal Business Name): SAMANTHA ANN STEELE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MS. SAMANTHA AS HOLLEY

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2369 BEAM ROAD
COLUMBUS IN
47203
US

IV. Provider business mailing address

2364 APPLEGATE DRIVE
COLUMBUS IN
47203
US

V. Phone/Fax

Practice location:
  • Phone: 812-378-4182
  • Fax: 812-378-4194
Mailing address:
  • Phone: 812-374-2129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number06003132A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: