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NPI Code Detail

MEDICARE: SAMANTHA RAE FREDERICK

MEDICARE: SAMANTHA RAE FREDERICK
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
1225700000XMassage TherapistMT137465TX

General Provider Information

NPI Number : 1861342453
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA RAE FREDERICK
Provider Business Mailing Address
First Line : 4008 E STAN SCHLUETER LOOP STE 108-109
Second Line :
City : KILLEEN
State : TX
Zip : 76542-8536
Country : US
Telephone Number : 254-245-8003
Fax Number : 254-245-8022
Provider Business Practice Location Address
First Line : 4008 E STAN SCHLUETER LOOP STE 108-109
Second Line :
City : KILLEEN
State : TX
Zip : 76542-8536
Country : US
Telephone Number : 254-245-8003
Fax Number : 254-245-8022
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2026
Last Update Date : 02/02/2026

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Directions to “ SAMANTHA RAE FREDERICK ” Practice Location

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