Active NPI
Samantha E Vanderburg, PTA
- Physical Therapy Assistant
- Broken Arrow, OK
National Provider Identifier
1316513583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2928
- Practice address
- 204 S Sweet Gum PL
Broken Arrow, OK 74012-4587 - Phone
- (918) 284-4220
- Fax
- (918) 249-2817
- NPI assigned
- May 28, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2928 | OK | Primary |
Addresses
Primary practice location
204 S Sweet Gum PL
Broken Arrow, OK 74012-4587
Mailing address
2608 W Kenosha St # 496
Broken Arrow, OK 74012-8952
Phone (918) 284-4220
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2928 | OK | MD | Obesity and Weight Management Nutrition Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622160000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622160000000",
"number": "1316513583",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2608 W KENOSHA ST # 496",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740128952",
"telephone_number": "918-284-4220",
"fax_number": "918-249-2817"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 S SWEET GUM PL",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740124587",
"telephone_number": "918-284-4220",
"fax_number": "918-249-2817"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERBURG",
"first_name": "SAMANTHA",
"middle_name": "E",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-28",
"last_updated": "2021-05-28",
"certification_date": "2021-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OK",
"license": "2928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.