Provider Demographics
NPI:1477330298
Name:SMATROV, ALEXANDER
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:SMATROV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALIAKSANDR
Other - Middle Name:
Other - Last Name:SMATROV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1006 GLEN LAUREL DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-8003
Mailing Address - Country:US
Mailing Address - Phone:980-205-3078
Mailing Address - Fax:
Practice Address - Street 1:127 MURRAH DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2390
Practice Address - Country:US
Practice Address - Phone:980-205-3078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3827225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant