Active NPI
Samantha L. Szostak, PT, DPT
- Physical Therapist
- Charleston, WV
National Provider Identifier
1639622582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 004094
- Practice address
- 4301 Maccorkle Ave SE
Charleston, WV 25304-2503 - Phone
- (304) 720-9185
- NPI assigned
- Jul 27, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2305210468 | VA | |
| Physical Therapist | 225100000X | 004094 | WV | Primary |
Addresses
Primary practice location
4301 Maccorkle Ave SE
Charleston, WV 25304-2503
Mailing address
4301 Maccorkle Ave SE
Charleston, WV 25304-2503
Phone (304) 720-9185
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C05954 | Other | VA | GROUP MEDICARE PTAN |
| 1639622582 | Other | VA | MEDICAID QMB ONLY |
Other names 1
- Samantha L. Bruggeman
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2305210468 | VA | MD | Physical Therapist |
| 004094 | WV | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469577600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554768000000",
"number": "1639622582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4301 MACCORKLE AVE SE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253042503",
"telephone_number": "304-720-9185",
"fax_number": "304-720-9186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4301 MACCORKLE AVE SE",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253042503",
"telephone_number": "304-720-9185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SZOSTAK",
"first_name": "SAMANTHA",
"middle_name": "L.",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-27",
"last_updated": "2019-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "VA",
"license": "2305210468",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "004094",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP MEDICARE PTAN",
"identifier": "C05954",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID QMB ONLY",
"identifier": "1639622582",
"state": "VA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SAMANTHA",
"last_name": "BRUGGEMAN",
"middle_name": "L.",
"credential": "PT, DPT",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.