Provider Demographics
NPI:1851385314
Name:SMITH, BRIAN PAUL (ATC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:PAUL
Last Name:SMITH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6511 PRINCESS GARDEN PKWY
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3538
Mailing Address - Country:US
Mailing Address - Phone:240-387-1283
Mailing Address - Fax:301-552-2775
Practice Address - Street 1:6511 PRINCESS GARDEN PKWY
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3538
Practice Address - Country:US
Practice Address - Phone:240-387-1283
Practice Address - Fax:301-552-2775
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer