Healthcare Provider Details

I. General information

NPI: 1346868007
Provider Name (Legal Business Name): SAMANTHA JO GARDNER DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA JO ROOKS

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 W MAIN ST STE 120
NORTHVILLE MI
48167-1548
US

IV. Provider business mailing address

9368 N LILLEY RD
PLYMOUTH MI
48170-4610
US

V. Phone/Fax

Practice location:
  • Phone: 248-347-1168
  • Fax: 248-347-1252
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501019626
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: