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NPI Code Detail

MEDICARE: KATHLEEN ANNE SMART PTA

MEDICARE: KATHLEEN ANNE SMART PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant

General Provider Information

NPI Number : 1225697758
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN ANNE SMART PTA
Provider Business Mailing Address
First Line : 1450 OLD POLK CITY RD
Second Line :
City : LAKELAND
State : FL
Zip : 33809-2381
Country : US
Telephone Number : 863-608-1321
Fax Number :
Provider Business Practice Location Address
First Line : 1919 LAKELAND HILLS BLVD
Second Line :
City : LAKELAND
State : FL
Zip : 33805-2901
Country : US
Telephone Number : 863-688-5612
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2019
Last Update Date : 06/09/2019

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Directions to “ KATHLEEN ANNE SMART PTA” Practice Location

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