Provider Demographics
NPI:1417440900
Name:SMITH, AMAURI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:AMAURI
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:912-638-1444
Mailing Address - Fax:912-638-0077
Practice Address - Street 1:212 RETREAT VLG
Practice Address - Street 2:
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-2403
Practice Address - Country:US
Practice Address - Phone:912-638-1444
Practice Address - Fax:912-638-0077
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013206225100000X
SC9423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA049767968OtherDRIVER LICENSE