Provider Demographics
NPI:1215968110
Name:SMITH, SHANE T (PT)
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:2500 WINCHESTER PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-1550
Mailing Address - Country:US
Mailing Address - Phone:864-574-7282
Mailing Address - Fax:864-574-7664
Practice Address - Street 1:2500 WINCHESTER PL
Practice Address - Street 2:SUITE 100
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-1550
Practice Address - Country:US
Practice Address - Phone:864-574-7282
Practice Address - Fax:864-574-7664
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-08-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC3441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ59627Medicare UPIN