Provider Demographics
NPI:1902338676
Name:MANHARDT, SAMANTHA WILSON (DPT)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:WILSON
Last Name:MANHARDT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1330 QUAIL LAKE LOOP
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4651
Mailing Address - Country:US
Mailing Address - Phone:719-579-0230
Mailing Address - Fax:719-579-0277
Practice Address - Street 1:1330 QUAIL LAKE LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4651
Practice Address - Country:US
Practice Address - Phone:719-579-0230
Practice Address - Fax:719-579-0277
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0014665225100000X
MSCP00391T225100000X
NCP16891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist