Provider Demographics
NPI:1427681642
Name:SMITH, ANITA J (PTA)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:722 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-3922
Mailing Address - Country:US
Mailing Address - Phone:620-670-5571
Mailing Address - Fax:620-670-5572
Practice Address - Street 1:722 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-3922
Practice Address - Country:US
Practice Address - Phone:620-670-5571
Practice Address - Fax:620-670-5572
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03579225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant