MEDICARE: SAMANTHA BROWN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00421	OTHER	OH	LICENSE#

General Provider Information

NPI Number	:	1356498877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA BROWN

Provider Business Mailing Address
First Line	:	2222 HYDE SHAFFER RD
Second Line	:
City	:	BRISTOLVILLE
State	:	OH
Zip	:	44402-9771
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2614 E MARKET ST
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-6204
Country	:	US
Telephone Number	:	330-394-8282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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Directions to “ SAMANTHA BROWN ” Practice Location

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