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General NPI Number Information
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NPI Number | 1720451412
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Entity Type | Individual
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Provider Name | SAMANTHA SMITH PT, DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 163 NORTHPORT AVE
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City | BELFAST
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State | ME
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Zip | 04915-6192
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Country | US
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Telephone | 207-505-4584
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Fax |
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Provider Business Mailing Address
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Address Line | 163 NORTHPORT AVE
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City | BELFAST
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State | ME
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Zip | 04915-6192
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Country | US
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Telephone | 207-505-4584
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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 | AT476
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License Number State | ME
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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 | PT3960
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License Number State | ME
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