Provider Demographics
NPI:1609400688
Name:SMITHSON, ELLIOT VICTOR (DPT, ATC, EMT)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:VICTOR
Last Name:SMITHSON
Suffix:
Gender:M
Credentials:DPT, ATC, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 SPRING RUN CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-5029
Mailing Address - Country:US
Mailing Address - Phone:407-415-3712
Mailing Address - Fax:
Practice Address - Street 1:401 S CAMDEN DR APT 8
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4263
Practice Address - Country:US
Practice Address - Phone:407-415-3712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298206225100000X
FL35555225100000X
FL554022146N00000X
FL35322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer