Samantha Bussard

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2306606242 Issued in VA

Practice address

2300 Pavilion Dr
Kingsport, TN 37660-4622

Phone

(423) 765-9655

NPI assigned

Sep 7, 2023

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694044800000",
    "number": "1235915075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1229 CHURCH HILL RD",
            "city": "LEBANON",
            "state": "VA",
            "postal_code": "242663948",
            "telephone_number": "276-880-5351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 PAVILION DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604622",
            "telephone_number": "423-765-9655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUSSARD",
        "first_name": "SAMANTHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-07",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TN",
            "license": "8276",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "VA",
            "license": "2306606242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Henry Burleson, M.D.
• Amanda Susan Burns, ARNP
• Riann J Burroughs, FNP
• Floyd Vernon Burton, M.D.
• Shawn Robert Busche, OD
• Cindy Sue Butler, N.P.
• Steven C Butler, M.D.
• Cassandra Butts, RN
• Donna Butts, RN
• Marcus K Byler, NP

• Physical Therapy Assistant in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Physical Therapy Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.