Provider Demographics
NPI:1700224615
Name:SMITH, CYNTHIA CHRISTOPHER (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:CHRISTOPHER
Last Name:SMITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 SCOTLAND DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7654
Mailing Address - Country:US
Mailing Address - Phone:803-528-8912
Mailing Address - Fax:
Practice Address - Street 1:308 SCOTLAND DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-7654
Practice Address - Country:US
Practice Address - Phone:803-528-8912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2923225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant