Provider Demographics
NPI:1063662690
Name:SMITH, SHEILA MARIE (PTA)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7107 S 145TH ST APT 24
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68138-6911
Mailing Address - Country:US
Mailing Address - Phone:308-571-0006
Mailing Address - Fax:
Practice Address - Street 1:2027 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:ELK HORN
Practice Address - State:IA
Practice Address - Zip Code:51531-8007
Practice Address - Country:US
Practice Address - Phone:712-764-4201
Practice Address - Fax:712-764-6200
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE767225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant