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General NPI Number Information
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NPI Number | 1356909576
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Entity Type | Individual
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Provider Name | SAMANTHA WHALEN ATC, PT
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Gender | Female
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Dates
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Enumeration Date | 06/03/2019
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 1541 OLD BAYSHORE HWY
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City | BURLINGAME
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State | CA
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Zip | 94010-1602
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Country | US
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Telephone | 925-784-5853
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Fax |
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Provider Business Mailing Address
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Address Line | 5567 HELGA CT
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City | LIVERMORE
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State | CA
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Zip | 94550-8142
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000042734
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT306731
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License Number State | CA
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