Provider Demographics
NPI:1326223439
Name:SMERICK, AMY M (PTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:SMERICK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:DUFON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 2829
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-2829
Mailing Address - Country:US
Mailing Address - Phone:912-756-5699
Mailing Address - Fax:912-756-5388
Practice Address - Street 1:512 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4325
Practice Address - Country:US
Practice Address - Phone:912-368-4131
Practice Address - Fax:912-368-4132
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA002123225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant