MEDICARE: MS. ANNE 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	589	MA

General Provider Information

NPI Number	:	1255727582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANNE SMITH

Provider Business Mailing Address
First Line	:	PO BOX 934
Second Line	:
City	:	NORTHAMPTON
State	:	MA
Zip	:	01061-0934
Country	:	US
Telephone Number	:	413-397-3590
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 GREY OAK LN
Second Line	:
City	:	SOUTH DEERFIELD
State	:	MA
Zip	:	01373-9619
Country	:	US
Telephone Number	:	414-397-3590
Fax Number	:

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

Provider Enumeration Date	:	04/14/2015
Last Update Date	:	04/14/2015

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