Basic Information
| Provider Information | |||||||||
| NPI: | 1467771808 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMALLWOOD | ||||||||
| FirstName: | TOWNSLEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1513C SUN CITY CENTER PLAZA | ||||||||
| Address2: | |||||||||
| City: | SUN CITY CENTER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136346022 | ||||||||
| FaxNumber: | 7732846820 | ||||||||
| Practice Location | |||||||||
| Address1: | 1513 SUN CITY CENTER PLZ STE C | ||||||||
| Address2: | |||||||||
| City: | SUN CITY CENTER | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335735390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136346022 | ||||||||
| FaxNumber: | 8136346053 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2010 | ||||||||
| LastUpdateDate: | 10/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 160-004788 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | 225200000X | PTA22836 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1467771808 | 05 | FL | MEDICAID |