MEDICARE: JAVANA SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	014389	NY

General Provider Information

NPI Number	:	1013628296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVANA SMITH

Provider Business Mailing Address
First Line	:	5850 GRANITE PKWY STE 600
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-6753
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 HOLLOW LN STE 214
Second Line	:
City	:	NORTH NEW HYDE PARK
State	:	NY
Zip	:	11042-1215
Country	:	US
Telephone Number	:	516-482-0100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2022
Last Update Date	:	05/06/2026

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Directions to “ JAVANA SMITH ” Practice Location

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