Provider Demographics
NPI:1790751063
Name:SMITH, CATHERINE JILL (PTA)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:JILL
Last Name:SMITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:JILL
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:117 BILL JOHNSON RD NE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-7992
Mailing Address - Country:US
Mailing Address - Phone:478-451-0037
Mailing Address - Fax:
Practice Address - Street 1:571 HAMMOCK RD NW
Practice Address - Street 2:SUITE 106
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7184
Practice Address - Country:US
Practice Address - Phone:478-452-6252
Practice Address - Fax:478-452-6255
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1172225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant