Provider Demographics
NPI:1558924639
Name:SMYSER, STEVEN EDWARD (LPTA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:EDWARD
Last Name:SMYSER
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-1423
Mailing Address - Country:US
Mailing Address - Phone:660-582-1301
Mailing Address - Fax:
Practice Address - Street 1:814 W SOUTH AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-2772
Practice Address - Country:US
Practice Address - Phone:660-582-8161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002030703225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant