Provider Demographics
NPI:1558964296
Name:SMART, BRITTANY (PTA)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:
Last Name:SMART
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:STOVALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:109 BRIDGE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1222
Mailing Address - Country:US
Mailing Address - Phone:434-793-4711
Mailing Address - Fax:434-797-2514
Practice Address - Street 1:1075 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-4506
Practice Address - Country:US
Practice Address - Phone:276-790-3233
Practice Address - Fax:276-790-3242
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306604805225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2306604805OtherVA STATE LICENSE