Provider Demographics
NPI:1679649008
Name:STAHL, SAMANTHA ALLISON (MPT)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:ALLISON
Last Name:STAHL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:SAMANTHA
Other - Middle Name:ALLISON
Other - Last Name:STAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:3989 E ARAPAHOE ROAD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-7044
Mailing Address - Country:US
Mailing Address - Phone:303-740-2026
Mailing Address - Fax:303-770-5459
Practice Address - Street 1:3989 E ARAPAHOE ROAD
Practice Address - Street 2:SUITE 120
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-7044
Practice Address - Country:US
Practice Address - Phone:303-740-2026
Practice Address - Fax:303-770-5459
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT007370225100000X, 2251P0200X, 2251S0007X, 2251X0800X
CO0015681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000942356BMedicaid
GA10032935OtherAMERIGROUP
GA317670OtherWELLCARE