Provider Demographics
NPI:1164551073
Name:SMITH, STANLEY DAVID (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:DAVID
Last Name:SMITH
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 W SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17702-6944
Mailing Address - Country:US
Mailing Address - Phone:570-320-0129
Mailing Address - Fax:
Practice Address - Street 1:700 PERCY ST
Practice Address - Street 2:
Practice Address - City:S WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17702-7522
Practice Address - Country:US
Practice Address - Phone:570-326-2684
Practice Address - Fax:570-326-2687
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001043A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer