Provider Demographics
NPI:1174015820
Name:SMOTHERMON, MARK (DPT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:SMOTHERMON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9535
Mailing Address - Country:US
Mailing Address - Phone:941-918-9575
Mailing Address - Fax:941-346-9646
Practice Address - Street 1:1076 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9535
Practice Address - Country:US
Practice Address - Phone:941-918-9575
Practice Address - Fax:941-346-9646
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist