Provider Demographics
NPI:1114365053
Name:SMITH, MICHAEL GRADY (SCAT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GRADY
Last Name:SMITH
Suffix:
Gender:M
Credentials:SCAT
Other - Prefix:MR
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SCAT
Mailing Address - Street 1:275 E ALEXANDER LOVE HWY
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-5502
Mailing Address - Country:US
Mailing Address - Phone:803-818-6274
Mailing Address - Fax:803-684-1506
Practice Address - Street 1:275 E ALEXANDER LOVE HWY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-5502
Practice Address - Country:US
Practice Address - Phone:803-818-6274
Practice Address - Fax:803-684-1506
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer