Provider Demographics
NPI:1487759908
Name:SMITH, SHARON LYNN
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ATRIUM WAY
Mailing Address - Street 2:STE 232 CAROLINA PHYSICAL THERAPY AND SPORTS MEDICINE,
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6371
Mailing Address - Country:US
Mailing Address - Phone:803-788-8484
Mailing Address - Fax:803-788-8499
Practice Address - Street 1:115 ATRIUM WAY
Practice Address - Street 2:STE 232 CAROLINA PHYSICAL THERAPY AND SPORTS MEDICINE,
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6371
Practice Address - Country:US
Practice Address - Phone:803-788-8484
Practice Address - Fax:803-788-8499
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1011208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP936608614Medicare ID - Type Unspecified