Provider Demographics
NPI:1265612386
Name:SMITH, TABITHA ANNE (PTA)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 EISENHART DR
Mailing Address - Street 2:
Mailing Address - City:ABBOTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17301-9057
Mailing Address - Country:US
Mailing Address - Phone:717-259-7683
Mailing Address - Fax:
Practice Address - Street 1:2990 CARLISLE PIKE
Practice Address - Street 2:
Practice Address - City:NEW OXFORD
Practice Address - State:PA
Practice Address - Zip Code:17350-9582
Practice Address - Country:US
Practice Address - Phone:717-624-2161
Practice Address - Fax:717-624-5252
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI000717225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant