Provider Demographics
NPI:1285991513
Name:SMITH-BUAH, ERAL M (PTA)
Entity type:Individual
Prefix:
First Name:ERAL
Middle Name:M
Last Name:SMITH-BUAH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15607 DORSET RD
Mailing Address - Street 2:301
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5339
Mailing Address - Country:US
Mailing Address - Phone:240-463-7290
Mailing Address - Fax:
Practice Address - Street 1:11506 NICHOLAS ST
Practice Address - Street 2:110
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4407
Practice Address - Country:US
Practice Address - Phone:402-612-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3750225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant