Individual
SAMANTHA BUSSARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2300 PAVILION DR, KINGSPORT, TN 37660-4622
(423) 765-9655
Mailing address
1229 CHURCH HILL RD, LEBANON, VA 24266-3948
(276) 880-5351
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306606242
VA
225200000X
Physical Therapy Assistant
8276
TN
Other
Enumeration date
09/07/2023
Last updated
09/07/2023
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