Provider Demographics
NPI:1164029096
Name:SMITH, AARON
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
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 1:1714 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1110
Mailing Address - Country:US
Mailing Address - Phone:919-791-6678
Mailing Address - Fax:
Practice Address - Street 1:510 TIMBER DR E STE 102
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-5285
Practice Address - Country:US
Practice Address - Phone:919-500-5003
Practice Address - Fax:910-500-5012
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist