Healthcare Provider Details

I. General information

NPI: 1730669417
Provider Name (Legal Business Name): PATRICK SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6931 W SUNRISE BLVD
PLANTATION FL
33313-4406
US

IV. Provider business mailing address

15108 NW 7TH CT
PEMBROKE PINES FL
33028-1851
US

V. Phone/Fax

Practice location:
  • Phone: 954-583-6200
  • Fax:
Mailing address:
  • Phone: 305-992-2348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number22867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: