Provider Demographics
NPI:1952599219
Name:SMITH, ANNE L (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MR
Other - First Name:ANNE
Other - Middle Name:LANGLOIS
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:196 VINING CT
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-6658
Mailing Address - Country:US
Mailing Address - Phone:386-212-3696
Mailing Address - Fax:
Practice Address - Street 1:196 VINING CT
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-6658
Practice Address - Country:US
Practice Address - Phone:386-212-3696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA22011172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist