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General NPI Number Information
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NPI Number | 1811705726
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Entity Type | Individual
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Provider Name | SAMATHA THACH PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 12/23/2024
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Last Update Date | 12/23/2024
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Provider Practice Location Address
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Address Line | 3104 BRIDGEBORO RD STE B
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City | DELRAN
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State | NJ
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Zip | 08075-9716
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Country | US
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Telephone | 856-460-6424
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Fax | 856-544-3286
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Provider Business Mailing Address
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Address Line | 14 PARKE PLACE BLVD STE D
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City | SEWELL
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State | NJ
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Zip | 08080-2662
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Country | US
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Telephone | 856-256-8393
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Fax | 856-256-8390
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02253300
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License Number State | NJ
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