Provider Demographics
NPI:1003848631
Name:SMITH, WAYNE DOUGLAS (PT ATC)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:DOUGLAS
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SHERIDAN CIRCLE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6025
Mailing Address - Country:US
Mailing Address - Phone:843-815-4080
Mailing Address - Fax:843-815-4084
Practice Address - Street 1:55 SHERIDAN CIRCLE
Practice Address - Street 2:SUITE A
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6025
Practice Address - Country:US
Practice Address - Phone:843-815-4080
Practice Address - Fax:843-815-4084
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist