Provider Demographics
NPI:1609339100
Name:SMITH, AUBREY (PTA)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:AUBREY
Other - Middle Name:
Other - Last Name:PRATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1080 N 35TH ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49053-9761
Mailing Address - Country:US
Mailing Address - Phone:269-665-7043
Mailing Address - Fax:269-665-4080
Practice Address - Street 1:1080 N 35TH ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:MI
Practice Address - Zip Code:49053-9761
Practice Address - Country:US
Practice Address - Phone:269-665-7043
Practice Address - Fax:269-665-4080
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant