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General NPI Number Information
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NPI Number | 1083929467
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Entity Type | Individual
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Provider Name | MARINA ANNE SMITH PTA
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Gender | Female
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 08/10/2010
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Provider Practice Location Address
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Address Line | 507 DEER PARK RD
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City | DIX HILLS
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State | NY
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Zip | 11746-5207
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Country | US
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Telephone | 631-549-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 7 GLEN HOLLOW DR APT B17
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City | HOLTSVILLE
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State | NY
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Zip | 11742-2446
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Country | US
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Telephone | 631-737-9502
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 000265-1
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License Number State | NY
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