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NPI Code Detail

MEDICARE: MR. PATRICK STEVE SMITH JR. PTA

MEDICARE: MR. PATRICK STEVE SMITH JR. 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 Assistant1090SC

General Provider Information

NPI Number : 1912149287
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PATRICK STEVE SMITH JR. PTA
Provider Business Mailing Address
First Line : 833 3RD AVE
Second Line :
City : GEORGETOWN
State : SC
Zip : 29440-6956
Country : US
Telephone Number : 843-240-8836
Fax Number :
Provider Business Practice Location Address
First Line : 701 S MORGAN AVE
Second Line :
City : ANDREWS
State : SC
Zip : 29510-2959
Country : US
Telephone Number : 843-264-8933
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2009
Last Update Date : 04/01/2009

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