Provider Demographics
NPI:1215102314
Name:SMITH, DOROTHY J (LMT)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:958 MILLBROOK AVE
Mailing Address - Street 2:ST 1
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-0603
Mailing Address - Country:US
Mailing Address - Phone:803-649-0599
Mailing Address - Fax:803-502-1481
Practice Address - Street 1:958 MILLBROOK AVE
Practice Address - Street 2:STE 1
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-0603
Practice Address - Country:US
Practice Address - Phone:803-649-0599
Practice Address - Fax:803-502-1481
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5565225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist