Provider Demographics
NPI:1275840340
Name:SMILEY, KURT C (PTA)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:C
Last Name:SMILEY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WEST ST
Mailing Address - Street 2:APT. C-1
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4084
Mailing Address - Country:US
Mailing Address - Phone:774-360-4917
Mailing Address - Fax:
Practice Address - Street 1:41 WEST ST
Practice Address - Street 2:APT. C-1
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4084
Practice Address - Country:US
Practice Address - Phone:774-360-4917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8365225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant