Provider Demographics
NPI:1588669329
Name:SMYRL, SAE D (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:SAE
Middle Name:D
Last Name:SMYRL
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 JIM BERRY RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-8660
Mailing Address - Country:US
Mailing Address - Phone:828-369-7878
Mailing Address - Fax:828-369-8760
Practice Address - Street 1:235 JIM BERRY RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-8660
Practice Address - Country:US
Practice Address - Phone:828-369-7878
Practice Address - Fax:828-369-8760
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9861225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2506001Medicare ID - Type Unspecified