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NPI Code Detail

MEDICARE: MRS. KIMBERLY ANN SMITH PTA

MEDICARE: MRS. KIMBERLY ANN 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 Assistant3732TN
2225200000XPhysical Therapy Assistant160.004882IL

General Provider Information

NPI Number : 1427137835
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY ANN SMITH PTA
Provider Business Mailing Address
First Line : 106 TIMBER TRL
Second Line :
City : CARTERVILLE
State : IL
Zip : 62918-2377
Country : US
Telephone Number : 615-473-8161
Fax Number :
Provider Business Practice Location Address
First Line : 120 N TOWER RD
Second Line :
City : CARBONDALE
State : IL
Zip : 62901-1929
Country : US
Telephone Number : 618-549-3355
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2006
Last Update Date : 12/31/2020

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