Provider Demographics
NPI:1730324831
Name:BROWN, SAMANTHA K (PT)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:K
Last Name:BROWN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:K
Other - Last Name:LEHECKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:35 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-1045
Mailing Address - Country:US
Mailing Address - Phone:713-550-6803
Mailing Address - Fax:
Practice Address - Street 1:1 EVERGREEN DR
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1503
Practice Address - Country:US
Practice Address - Phone:401-438-3250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02183225100000X
TX1178340225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist