Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2123715 | TX |
NPI | 1013492479 |
---|---|
Provider Name | Sheridan Smith |
First Address | Forney, TX 75126-6261 |
Second Address | Forney, TX 75126-6261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2018 |
Last Update Date | 01/10/2018 |