Provider Demographics
NPI:1679953962
Name:ASHENBRENER, SAMANTHA LEA (DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEA
Last Name:ASHENBRENER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:LEA
Other - Last Name:SHUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:754 N COLLEGE RD
Mailing Address - Street 2:STE D
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5822
Mailing Address - Country:US
Mailing Address - Phone:208-734-5313
Mailing Address - Fax:208-736-1582
Practice Address - Street 1:754 N COLLEGE RD
Practice Address - Street 2:STE D
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5822
Practice Address - Country:US
Practice Address - Phone:208-734-5313
Practice Address - Fax:208-736-1582
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-3807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1679953962Medicaid
IDP01582594OtherRR MEDICARE
ID1679953962Medicaid