Provider Demographics
NPI:1912149287
Name:SMITH, PATRICK STEVE JR (PTA)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:STEVE
Last Name:SMITH
Suffix:JR
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 1:833 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-6956
Mailing Address - Country:US
Mailing Address - Phone:843-240-8836
Mailing Address - Fax:
Practice Address - Street 1:701 S MORGAN AVE
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:SC
Practice Address - Zip Code:29510-2959
Practice Address - Country:US
Practice Address - Phone:843-264-8933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1090225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant