MEDICARE: SAMANTHA LONG

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	2306603107	VA

General Provider Information

NPI Number	:	1568151033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LONG

Provider Business Mailing Address
First Line	:	432 AIRPORT RD
Second Line	:
City	:	CEDAR BLUFF
State	:	VA
Zip	:	24609-8887
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 CLINIC DR
Second Line	:
City	:	CEDAR BLUFF
State	:	VA
Zip	:	24609-9406
Country	:	US
Telephone Number	:	276-596-9750
Fax Number	:

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

Provider Enumeration Date	:	05/02/2023
Last Update Date	:	05/02/2023

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Directions to “ SAMANTHA LONG ” Practice Location

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