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General NPI Number Information
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NPI Number | 1225697758
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Entity Type | Individual
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Provider Name | KATHLEEN ANNE SMART PTA
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Gender | Female
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Dates
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Enumeration Date | 06/09/2019
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Last Update Date | 06/09/2019
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Provider Practice Location Address
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Address Line | 1919 LAKELAND HILLS BLVD
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City | LAKELAND
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State | FL
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Zip | 33805-2901
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Country | US
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Telephone | 863-688-5612
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 OLD POLK CITY RD
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City | LAKELAND
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State | FL
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Zip | 33809-2381
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Country | US
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Telephone | 863-608-1321
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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