Healthcare Provider Details

I. General information

NPI: 1700366523
Provider Name (Legal Business Name): PRADEEPIKA SAMAGH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 LUNENBURG COUNTY RD, KEYSVILLE, VA 23947
KEYSVILLE VA
23947
US

IV. Provider business mailing address

730 LUNENBURG COUNTY RD, KEYSVILLE, VA 23947
KEYSVILLE VA
23947
US

V. Phone/Fax

Practice location:
  • Phone: 434-736-8406
  • Fax:
Mailing address:
  • Phone: 434-736-8406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305211786
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: