Provider Demographics
NPI:1770168452
Name:SMITH, ERIC KINDLE (PTA)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:KINDLE
Last Name:SMITH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 SAINTSBURY DR APT 229
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-5278
Mailing Address - Country:US
Mailing Address - Phone:806-676-7994
Mailing Address - Fax:
Practice Address - Street 1:3208 THUNDERBIRD LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-2321
Practice Address - Country:US
Practice Address - Phone:972-422-2214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2155646225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant