Provider Demographics
NPI:1740466978
Name:SMART PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:SMART PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:HIMIC
Authorized Official - Last Name:CMAR
Authorized Official - Suffix:
Authorized Official - Credentials:BS, PTA
Authorized Official - Phone:561-799-0104
Mailing Address - Street 1:1983 PGA BLVD STE 105B
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3001
Mailing Address - Country:US
Mailing Address - Phone:561-799-0104
Mailing Address - Fax:561-799-0460
Practice Address - Street 1:1983 PGA BLVD STE 105B
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33408-3001
Practice Address - Country:US
Practice Address - Phone:561-799-0104
Practice Address - Fax:561-799-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19901261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy