MEDICARE: ANITA J 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
1	225200000X	Physical Therapy Assistant	14-03579	KS

General Provider Information

NPI Number	:	1427681642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA J SMITH PTA

Provider Business Mailing Address
First Line	:	722 N BROADWAY ST
Second Line	:
City	:	PITTSBURG
State	:	KS
Zip	:	66762-3922
Country	:	US
Telephone Number	:	620-670-5571
Fax Number	:	620-670-5572

Provider Business Practice Location Address
First Line	:	722 N BROADWAY ST
Second Line	:
City	:	PITTSBURG
State	:	KS
Zip	:	66762-3922
Country	:	US
Telephone Number	:	620-670-5571
Fax Number	:	620-670-5572

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

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/25/2020

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Directions to “ ANITA J SMITH PTA” Practice Location

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