Provider Demographics
NPI:1417387226
Name:SMITH, PATRICK B (DPT)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:B
Last Name:SMITH
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 1:800 SHENANDOAH AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ELKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22827
Mailing Address - Country:US
Mailing Address - Phone:540-298-4749
Mailing Address - Fax:540-298-4570
Practice Address - Street 1:800 SHENANDOAH AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:ELKTON
Practice Address - State:VA
Practice Address - Zip Code:22827
Practice Address - Country:US
Practice Address - Phone:540-298-4749
Practice Address - Fax:540-298-4570
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305208415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist