MEDICARE: PARINITA SHANTA SMITH P.T.

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	225100000X	Physical Therapist	19394	FL

General Provider Information

NPI Number	:	1700886538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARINITA SHANTA SMITH P.T.

Provider Business Mailing Address
First Line	:	3670 HENDERSON BLVD
Second Line	:	SUITE A
City	:	TAMPA
State	:	FL
Zip	:	33609-4515
Country	:	US
Telephone Number	:	813-877-6664
Fax Number	:	813-877-8799

Provider Business Practice Location Address
First Line	:	3670 HENDERSON BLVD
Second Line	:	SUITE A
City	:	TAMPA
State	:	FL
Zip	:	33609-4515
Country	:	US
Telephone Number	:	813-258-8020
Fax Number	:	813-877-8799

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	08/02/2021

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