Provider Demographics
NPI:1831311661
Name:SMITH, ANTHONY C (ATC, PTA)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 BLOOMING GROVE RD
Mailing Address - Street 2:SPORT CENTER PHYSICAL THERAPY
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-7917
Mailing Address - Country:US
Mailing Address - Phone:717-632-3431
Mailing Address - Fax:717-633-5143
Practice Address - Street 1:207 BLOOMING GROVE RD
Practice Address - Street 2:SPORT CENTER PHYSICAL THERAPY
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-7917
Practice Address - Country:US
Practice Address - Phone:717-632-3431
Practice Address - Fax:717-633-5143
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000953A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA22Medicare UPIN