Provider Demographics
NPI:1619704665
Name:BROWN, SAMANTHA E (PTA, CSCS)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:E
Last Name:BROWN
Suffix:
Gender:F
Credentials:PTA, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 VISTA CLIFF CIR
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-5526
Mailing Address - Country:US
Mailing Address - Phone:303-859-9109
Mailing Address - Fax:
Practice Address - Street 1:7280 LAGAE RD STE E&F
Practice Address - Street 2:
Practice Address - City:CASTLE PINES
Practice Address - State:CO
Practice Address - Zip Code:80108-9452
Practice Address - Country:US
Practice Address - Phone:720-523-8460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA33048225200000X
COPTA14639225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant