Provider Demographics
NPI:1720037740
Name:SMITH, ROXANNE JANENE (DPT, ATC)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:JANENE
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 SUGARTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-2800
Mailing Address - Country:US
Mailing Address - Phone:610-647-1481
Mailing Address - Fax:
Practice Address - Street 1:20 W BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-2101
Practice Address - Country:US
Practice Address - Phone:610-626-0080
Practice Address - Fax:610-626-0084
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT016944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist