Provider Demographics
NPI:1215610035
Name:SMITH, PATRICIA A (LMT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:A
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 1:138 N LAKE CORTEZ DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4808
Mailing Address - Country:US
Mailing Address - Phone:407-335-8856
Mailing Address - Fax:
Practice Address - Street 1:2981 W STATE ROAD 434 STE 200
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4838
Practice Address - Country:US
Practice Address - Phone:407-335-8856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA72439225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist