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General NPI Number Information
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NPI Number | 1588924609
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Entity Type | Individual
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Provider Name | ANTHONY EDWARD SMITH PTA
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Gender | Male
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Dates
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Enumeration Date | 05/22/2012
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Last Update Date | 12/27/2018
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Provider Practice Location Address
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Address Line | 216 GARCIA ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87123-2604
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Country | US
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Telephone | 505-688-2001
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Fax |
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Provider Business Mailing Address
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Address Line | 1881 PEACH RD NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-5420
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Country | US
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Telephone | 505-688-2001
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 6783
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A-0867
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License Number State | NM
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