Healthcare Provider Details

I. General information

NPI: 1528736014
Provider Name (Legal Business Name): SAMANTHA POINDEXTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

894 LELAND AVE
SAINT LOUIS MO
63130-3239
US

IV. Provider business mailing address

10032 N MARLENE DR
AFFTON MO
63123-4016
US

V. Phone/Fax

Practice location:
  • Phone: 314-726-4767
  • Fax:
Mailing address:
  • Phone: 157-330-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: