MEDICARE: SAMANTHA COLLEEN CANUP

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	225100000X	Physical Therapist	12348	TN

General Provider Information

NPI Number	:	1770143190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA COLLEEN CANUP

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	615-373-7116

Provider Business Practice Location Address
First Line	:	3556 TOM AUSTIN HWY STE 2
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3960
Country	:	US
Telephone Number	:	615-492-4595
Fax Number	:	615-432-4292

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

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	06/05/2024

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Directions to “ SAMANTHA COLLEEN CANUP ” Practice Location

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