Provider Demographics
NPI:1255941092
Name:KASZUBSKI, SAMANTHA ERIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ERIN
Last Name:KASZUBSKI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12023 FOX HILL CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-7833
Mailing Address - Country:US
Mailing Address - Phone:845-988-6360
Mailing Address - Fax:
Practice Address - Street 1:5450 W HILLSBORO BLVD STE 9
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4317
Practice Address - Country:US
Practice Address - Phone:954-725-9125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist