Basic Information
| Provider Information | |||||||||
| NPI: | 1205261997 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | PATTI-JO | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CUBA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147271317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859682000 | ||||||||
| FaxNumber: | 5859683898 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CUBA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147271317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5859682000 | ||||||||
| FaxNumber: | 5859683898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2013 | ||||||||
| LastUpdateDate: | 09/12/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 005013 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.