Provider Demographics
NPI:1104874700
Name:SMITH, PAUL E JR (PT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SHADY CREEK CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-3013
Mailing Address - Country:US
Mailing Address - Phone:864-905-6609
Mailing Address - Fax:
Practice Address - Street 1:9 MAPLE TREE CT
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4070
Practice Address - Country:US
Practice Address - Phone:864-286-8288
Practice Address - Fax:864-286-8289
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6736Medicare ID - Type Unspecified
SCQ32199Medicare UPIN