Provider Demographics
NPI:1689808479
Name:MANTHA, SMITHA (DPM)
Entity Type:Individual
Prefix:DR
First Name:SMITHA
Middle Name:
Last Name:MANTHA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8411
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77288-8411
Mailing Address - Country:US
Mailing Address - Phone:214-335-7485
Mailing Address - Fax:832-369-1761
Practice Address - Street 1:12950 EAST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5710
Practice Address - Country:US
Practice Address - Phone:832-835-1422
Practice Address - Fax:832-369-1761
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2031213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist