MEDICARE: JEANNETTE SMITH

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
1	225200000X	Physical Therapy Assistant	21111	FL

General Provider Information

NPI Number	:	1548509318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNETTE SMITH

Provider Business Mailing Address
First Line	:	200 AVENUE K SE APT 228
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-4054
Country	:	US
Telephone Number	:	904-652-6463
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 AVENUE K SE APT 228
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-4054
Country	:	US
Telephone Number	:	904-652-6463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2013
Last Update Date	:	02/13/2013

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Directions to “ JEANNETTE SMITH ” Practice Location

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