Healthcare Provider Details

I. General information

NPI: 1487572251
Provider Name (Legal Business Name): SAMANTHA LOUDERMILK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 W JEFFERSON ST
FRANKLIN IN
46131-2177
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 317-668-0526
  • Fax: 317-315-8755
Mailing address:
  • Phone: 803-812-3656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05016436A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: