Provider Demographics
NPI:1326264011
Name:SMITH, BARBARA ANN (LMT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WASHINGTON DR
Mailing Address - Street 2:PO BOX 421
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1804
Mailing Address - Country:US
Mailing Address - Phone:631-427-1023
Mailing Address - Fax:
Practice Address - Street 1:301 WASHINGTON DR
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1804
Practice Address - Country:US
Practice Address - Phone:631-427-1023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011960225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist