Basic Information
| Provider Information | |||||||||
| NPI: | 1932790797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STITH | ||||||||
| FirstName: | SAMANTHA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2735 BERRYTOWN RD | ||||||||
| Address2: | |||||||||
| City: | RINEYVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401629737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703125452 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 RING RD | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTOWN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427014900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707065010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2021 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251P0200X | 004968 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No ID Information.