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General NPI Number Information
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NPI Number | 1588040620
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Entity Type | Individual
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Provider Name | SAMANTHA CAROLYN STEARNS PTA
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Gender | Female
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 514 WILLIAMSON RD STE 431
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City | MOORESVILLE
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State | NC
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Zip | 28117-9227
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Country | US
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Telephone | 704-360-2595
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Fax | 704-360-2596
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Provider Business Mailing Address
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Address Line | 21300 NAUTIQUE BLVD APT #303
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City | CORNELIUS
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State | NC
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Zip | 28031-6414
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Country | US
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Telephone | 704-236-4200
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A5717
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License Number State | NC
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