Provider Demographics
NPI:1497357370
Name:WILLIAMS, SAMANTHA L (LMT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16818 COBBLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-1915
Mailing Address - Country:US
Mailing Address - Phone:832-372-5142
Mailing Address - Fax:
Practice Address - Street 1:16818 COBBLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-1915
Practice Address - Country:US
Practice Address - Phone:832-372-5142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT121918225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist