Provider Demographics
NPI:1649658436
Name:SMITH, AUTUMN ELAINE (PTA)
Entity type:Individual
Prefix:MRS
First Name:AUTUMN
Middle Name:ELAINE
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 1:50 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:DRASCO
Mailing Address - State:AR
Mailing Address - Zip Code:72530-9299
Mailing Address - Country:US
Mailing Address - Phone:501-206-7440
Mailing Address - Fax:
Practice Address - Street 1:2000 HIGHWAY 25B STE A1
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-6418
Practice Address - Country:US
Practice Address - Phone:501-362-7195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2512225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant