Individual ProviderSamantha SmithPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address7767 Elm Creek Blvd N Ste 160, Maple Grove, MN 55369-7078(763) 201-8191PECOS EnrollmentBased on the most recent information from CMS, provider Samantha Smith does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1821644535Provider TypeIndividualFull NameSmith, SamanthaGenderFemaleSole ProprietorNoEnumeration Date8/18/2019Last Updated5/13/2021Contact InformationPractice LocationPractice Address7767 Elm Creek Blvd N Ste 160, Maple Grove, MN 55369-7078Phone(763) 201-8191FaxUnlisted FaxMailing LocationMailing Address9645 Grove Cir N Ste 200, Maple Grove, MN 55369-2684Phone(763) 201-8191FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense11562Minnesota