Provider Demographics
NPI:1811997430
Name:SMART, LAURA F (PT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:F
Last Name:SMART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:F
Other - Last Name:ECKERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2001 STULTS RD
Mailing Address - Street 2:ATTN: HOLLY SALE
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-1291
Mailing Address - Country:US
Mailing Address - Phone:260-355-3240
Mailing Address - Fax:260-355-3236
Practice Address - Street 1:2001 STULTS RD
Practice Address - Street 2:ATTN: HOLLY SALE
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1291
Practice Address - Country:US
Practice Address - Phone:260-355-3240
Practice Address - Fax:260-355-3236
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004076A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN132560YYMedicare ID - Type Unspecified