Provider Demographics
NPI:1699900175
Name:SMITH, TASHA LEE (LMT)
Entity type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:LEE
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 1:2720 NW 179TH AVE
Mailing Address - Street 2:1
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609
Mailing Address - Country:US
Mailing Address - Phone:352-371-1721
Mailing Address - Fax:
Practice Address - Street 1:2720 NW 6TH ST
Practice Address - Street 2:1
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2994
Practice Address - Country:US
Practice Address - Phone:352-371-1721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA20465225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC703OtherBCBS OF FL