Provider Demographics
NPI:1407362338
Name:SMITH PHYSICAL THERAPY AND WELLNESS
Entity Type:Organization
Organization Name:SMITH PHYSICAL THERAPY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT, MPT
Authorized Official - Phone:803-810-1186
Mailing Address - Street 1:2764 PLEASANT ROAD
Mailing Address - Street 2:SUITE A #10651
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-7299
Mailing Address - Country:US
Mailing Address - Phone:803-810-1186
Mailing Address - Fax:
Practice Address - Street 1:2435 HIGHWAY 160 WEST
Practice Address - Street 2:SUITE 108
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708
Practice Address - Country:US
Practice Address - Phone:803-810-1186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-14
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty