Provider Demographics
NPI:1053099721
Name:DUNLEAVY, SAMANTHA (CEP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DUNLEAVY
Suffix:
Gender:F
Credentials:CEP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:SCHLAMPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CEP
Mailing Address - Street 1:11198 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3231
Mailing Address - Country:US
Mailing Address - Phone:734-516-9392
Mailing Address - Fax:
Practice Address - Street 1:5325 ELLIOTT DR FL 2
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8633
Practice Address - Country:US
Practice Address - Phone:734-712-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI821048224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist