Basic Information
| Provider Information | |||||||||
| NPI: | 1578155263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BACHMAN | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 S COLLEGE AVE STE 160 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197131302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028318893 | ||||||||
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| Practice Location | |||||||||
| Address1: | 540 S COLLEGE AVE STE 160 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197131302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028318893 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2021 | ||||||||
| LastUpdateDate: | 02/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | J1-0014315 | DE | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.