Individual
SAMANTHA GANNAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
101 SAMMY FARRELL RD, MC GEHEE, AR 71654-9770
(870) 877-1675
Mailing address
101 SAMMY FARRELL RD, MC GEHEE, AR 71654-9770
(870) 877-1675
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4663
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4663
—
AR
Enumeration date
09/28/2021
Last updated
09/28/2021
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