Provider Demographics
NPI:1851107239
Name:DAIMARU SMITH, MISEI
Entity type:Individual
Prefix:
First Name:MISEI
Middle Name:
Last Name:DAIMARU SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11339 LITTLE PATUXENT PKWY APT 435
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3959
Mailing Address - Country:US
Mailing Address - Phone:917-294-1952
Mailing Address - Fax:
Practice Address - Street 1:11339 LITTLE PATUXENT PKWY APT 435
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3959
Practice Address - Country:US
Practice Address - Phone:917-294-1952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA5942225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant