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NPI Code Detail

MEDICARE: SHANNON MARIE SMITHSON PTA

MEDICARE: SHANNON MARIE SMITHSON 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 AssistantA8791NC

General Provider Information

NPI Number : 1457290876
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON MARIE SMITHSON PTA
Provider Business Mailing Address
First Line : 877 HILL EVERHART RD
Second Line :
City : LEXINGTON
State : NC
Zip : 27295-9140
Country : US
Telephone Number : 336-248-6644
Fax Number :
Provider Business Practice Location Address
First Line : 877 HILL EVERHART RD
Second Line :
City : LEXINGTON
State : NC
Zip : 27295-9140
Country : US
Telephone Number : 336-248-6644
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2026
Last Update Date : 03/30/2026

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