Provider Demographics
NPI:1710419536
Name:MYERS, SAMANTHA (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 303901
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-0068
Mailing Address - Country:US
Mailing Address - Phone:925-726-7073
Mailing Address - Fax:512-232-3988
Practice Address - Street 1:1300 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78722-2517
Practice Address - Country:US
Practice Address - Phone:925-726-7073
Practice Address - Fax:512-232-3988
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT94772255A2300X
FL55492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer