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NPI Code Detail

MEDICARE: MRS. TINA MARIE SMITH PTA

MEDICARE: MRS. TINA MARIE 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 Assistant70NE

General Provider Information

NPI Number : 1174156442
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TINA MARIE SMITH PTA
Provider Business Mailing Address
First Line : 1104 GRUNDMAN BLVD
Second Line :
City : NEBRASKA CITY
State : NE
Zip : 68410-3397
Country : US
Telephone Number : 402-873-7411
Fax Number : 402-873-7413
Provider Business Practice Location Address
First Line : 1104 GRUNDMAN BLVD
Second Line :
City : NEBRASKA CITY
State : NE
Zip : 68410-3397
Country : US
Telephone Number : 402-873-7411
Fax Number : 402-873-7413
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2020
Last Update Date : 02/14/2020

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