Healthcare Provider Details

I. General information

NPI: 1245749787
Provider Name (Legal Business Name): JAMES ZACHARY SMITH PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WESTWOOD ST
GLASGOW KY
42141-1030
US

IV. Provider business mailing address

221 GARMON AVE
GLASGOW KY
42141
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-9131
  • Fax:
Mailing address:
  • Phone: 270-590-4266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA03659
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: