Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 024573 | NY |
N | 2251P0200X | Physical Therapist - Pediatrics | 024573 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 024573 | NY |
NPI | 1285927780 |
---|---|
Provider Name | Sean Patrick Smith |
First Address | Massapequa Park, NY 11762 |
Second Address | Massapequa Park, NY 11762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2011 |
Last Update Date | 17/05/2011 |