Basic Information
| Provider Information | |||||||||
| NPI: | 1164029096 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | AARON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1714 CANTERBURY RD | ||||||||
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| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276081110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197916678 | ||||||||
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| Practice Location | |||||||||
| Address1: | 510 TIMBER DR E STE 102 | ||||||||
| Address2: | |||||||||
| City: | GARNER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275295285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195005003 | ||||||||
| FaxNumber: | 9105005012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2020 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | P19550 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.