Healthcare Provider Details

I. General information

NPI: 1154660116
Provider Name (Legal Business Name): SAMANTHA SIEBERT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2013
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 GOLF COURSE RD SE SUITE 106
RIO RANCHO NM
87124-1656
US

IV. Provider business mailing address

2113 GOLF COURSE RD SE SUITE 106
RIO RANCHO NM
87124-1656
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-9700
  • Fax: 505-898-8539
Mailing address:
  • Phone: 505-898-9700
  • Fax: 505-898-8539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4231
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: