Provider Demographics
NPI:1487138723
Name:CAGLE, SAMANTHA LEIGH (PT, DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEIGH
Last Name:CAGLE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 240302
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AK
Mailing Address - Zip Code:99824-0302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:507 W STEVENS AVE
Practice Address - Street 2:
Practice Address - City:SULTAN
Practice Address - State:WA
Practice Address - Zip Code:98294-9453
Practice Address - Country:US
Practice Address - Phone:360-799-0958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-22
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK188521225100000X
TX1308533225100000X
WA60892978225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist