Healthcare Provider Details

I. General information

NPI: 1558259473
Provider Name (Legal Business Name): JOHN RHETT SMITH CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

2743 RUTHERFORD WAY
CHARLESTON SC
29414-6687
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-6280
  • Fax:
Mailing address:
  • Phone: 843-789-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO004080
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: