Samantha Percich

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

2016027389 Issued in MO

Practice address

4280 S State Route 159
Glen Carbon, IL 62034-3269

Phone

(618) 288-4233

NPI assigned

Aug 4, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Samantha Schlake Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1470268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539302400000",
    "number": "1639623911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 APEX DR",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622491282",
            "telephone_number": "618-441-0482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4280 S STATE ROUTE 159",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343269",
            "telephone_number": "618-288-4233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERCICH",
        "first_name": "SAMANTHA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-04",
        "last_updated": "2018-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MO",
            "license": "2016027389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "SCHLAKE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nicole Parrish
• Patricia Lallish LCSW
• Ashley Peck
• Brooke Ann Pellok Harris, LPC
• Timothy J Penn, MD
• Zequielis M Perez Garcia
• Deanne Louise Perry, MSPT
• Rebecca Franke Philipps, PHARM.D.
• Christopher B Pifer, RPT
• Linette Pipkin, COTA/L

• Orthopedic Physical Therapist in Glen Carbon, IL
• Providers in Glen Carbon, IL by specialty
• Orthopedic Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2018; 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.