Provider Demographics
NPI:1467771808
Name:SMALLWOOD, TOWNSLEY (PTA)
Entity Type:Individual
Prefix:MR
First Name:TOWNSLEY
Middle Name:
Last Name:SMALLWOOD
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513C SUN CITY CENTER PLAZA
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573
Mailing Address - Country:US
Mailing Address - Phone:813-634-6022
Mailing Address - Fax:773-284-6820
Practice Address - Street 1:1513 SUN CITY CENTER PLZ STE C
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5390
Practice Address - Country:US
Practice Address - Phone:813-634-6022
Practice Address - Fax:813-634-6053
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160-004788225200000X
FLPTA22836225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1467771808Medicaid
FL1467771808Medicaid
FL1467771808Medicare PIN
FL341853567Medicare PIN