Provider Demographics
NPI:1194091926
Name:ALVIN, SMITHA (MS PT)
Entity type:Individual
Prefix:
First Name:SMITHA
Middle Name:
Last Name:ALVIN
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:SMITHA
Other - Middle Name:
Other - Last Name:OMANAMICHAELM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS PT
Mailing Address - Street 1:6171 9TH AVENUE CIR NE
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-9561
Mailing Address - Country:US
Mailing Address - Phone:586-215-9493
Mailing Address - Fax:941-666-6986
Practice Address - Street 1:3937 S ACCESS RD UNIT A
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224-3612
Practice Address - Country:US
Practice Address - Phone:586-215-9493
Practice Address - Fax:941-666-6986
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare PIN