Provider Demographics
NPI:1720396922
Name:SMITH, NANCY A (CMT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2020
Mailing Address - Country:US
Mailing Address - Phone:972-962-7688
Mailing Address - Fax:973-962-9606
Practice Address - Street 1:52 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:RINGWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07456-2020
Practice Address - Country:US
Practice Address - Phone:972-962-7688
Practice Address - Fax:973-962-9606
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26BT00117900225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist