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NPI Code Detail

MEDICARE: MS. ALBERTINE SMITH PTA

MEDICARE: MS. ALBERTINE SMITH PTA
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
1225200000XPhysical Therapy Assistant225200000XME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1225200000OTHERMEPHYSICAL THERAPY ASSISTANT

General Provider Information

NPI Number : 1033357850
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ALBERTINE SMITH PTA
Provider Business Mailing Address
First Line : 39 RANDOLPH DR
Second Line :
City : BANGOR
State : ME
Zip : 04401-2827
Country : US
Telephone Number : 207-478-5630
Fax Number :
Provider Business Practice Location Address
First Line : 105 MECHANIC ST
Second Line :
City : CAMDEN
State : ME
Zip : 04843-1811
Country : US
Telephone Number : 207-478-5630
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2009
Last Update Date : 10/23/2024

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