Provider Demographics
NPI:1992298392
Name:SMITH, ROBERT BRANDON (DPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRANDON
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:BRANDON
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:260 1ST AVE S STE 200-161
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4361
Mailing Address - Country:US
Mailing Address - Phone:727-308-9848
Mailing Address - Fax:727-502-6027
Practice Address - Street 1:1320 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4860
Practice Address - Country:US
Practice Address - Phone:727-308-9848
Practice Address - Fax:727-502-6027
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist