Provider Demographics
NPI:1891820023
Name:SMITH, ARTHUR J JR (PT)
Entity Type:Individual
Prefix:MR
First Name:ARTHUR
Middle Name:J
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:704 PROFESSIONAL PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-2000
Mailing Address - Country:US
Mailing Address - Phone:304-872-0490
Mailing Address - Fax:304-872-0492
Practice Address - Street 1:704 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-2000
Practice Address - Country:US
Practice Address - Phone:304-872-0490
Practice Address - Fax:304-872-0492
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV000301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0157391000Medicaid
WVSM0805901Medicare PIN