Healthcare Provider Details

I. General information

NPI: 1558964296
Provider Name (Legal Business Name): BRITTANY SMART PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY STOVALL PTA

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 SPRUCE ST
MARTINSVILLE VA
24112-4506
US

IV. Provider business mailing address

109 BRIDGE ST STE 300
DANVILLE VA
24541-1222
US

V. Phone/Fax

Practice location:
  • Phone: 276-790-3233
  • Fax: 276-790-3242
Mailing address:
  • Phone: 434-793-4711
  • Fax: 434-797-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306604805
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: