Provider Demographics
NPI:1073804100
Name:SMITH, PAUL ANTHONY
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 COLLEGE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-8900
Mailing Address - Country:US
Mailing Address - Phone:843-687-3757
Mailing Address - Fax:
Practice Address - Street 1:4828 COLLEGE LAKE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-8900
Practice Address - Country:US
Practice Address - Phone:843-687-3757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-24
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1608225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant