Individual
SAMANTHA STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
6330 E 75TH ST STE 206, INDIANAPOLIS, IN 46250-2700
(317) 284-1166
Mailing address
6330 E 75TH ST STE 206, INDIANAPOLIS, IN 46250-2700
(317) 284-1166
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
99086488A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
99086488A
PHYSICAL THERAPIST
IN
Enumeration date
05/29/2018
Last updated
05/29/2018
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