Provider Demographics
NPI:1114759347
Name:CHILDRESS, SAMANTHA CHEYENNE (DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:CHEYENNE
Last Name:CHILDRESS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 BARREN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLOW ROCK
Mailing Address - State:TN
Mailing Address - Zip Code:38342-3066
Mailing Address - Country:US
Mailing Address - Phone:731-358-9446
Mailing Address - Fax:
Practice Address - Street 1:8700 N TARRANT PKWY STE 113
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-8464
Practice Address - Country:US
Practice Address - Phone:817-498-8344
Practice Address - Fax:817-498-4008
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15978225100000X
KYCP038846T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist