Provider Demographics
NPI:1962645416
Name:SMITH, ANNA B (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:B
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3054 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2755
Mailing Address - Country:US
Mailing Address - Phone:814-234-6023
Mailing Address - Fax:814-234-1439
Practice Address - Street 1:3054 ENTERPRISE DR
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2755
Practice Address - Country:US
Practice Address - Phone:814-234-6023
Practice Address - Fax:814-234-1439
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019699225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT019699OtherLICENSE #