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General NPI Number Information
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NPI Number | 1962587972
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Entity Type | Individual
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Provider Name | SHERYL SMITH PTA
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Gender | Female
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1052 E WASHINGTON ST
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City | STEPHENVILLE
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State | TX
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Zip | 76401-4558
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Country | US
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Telephone | 254-965-3611
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Fax | 254-965-3618
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Provider Business Mailing Address
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Address Line | 2804 GALAXY ST
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City | GRANBURY
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State | TX
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Zip | 76049-1352
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Country | US
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Telephone | 817-573-6450
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Fax | 254-965-3618
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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 | 2021788
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License Number State | TX
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