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General NPI Number Information
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NPI Number | 1992357966
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Entity Type | Individual
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Provider Name | STEPHANIE JANAE SMITH PTA
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Gender | Female
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Dates
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Enumeration Date | 07/10/2019
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Last Update Date | 07/10/2019
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Provider Practice Location Address
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Address Line | 11203 MAIN ST
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City | MARTIN
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State | KY
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Zip | 41649-7999
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Country | US
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Telephone | 606-285-6670
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Fax |
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Provider Business Mailing Address
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Address Line | 59 PERRYS TOWN RD
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City | GARNER
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State | KY
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Zip | 41817-9100
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Country | US
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Telephone | 606-634-1765
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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 | A02406
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License Number State | KY
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