Individual
MR. JOHN VICTOR SMITH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1203 E 22ND AVE, TAMPA, FL 33605-1719
(813) 229-6901
(813) 229-0091
Mailing address
105 N 5TH AVE, MADILL, OK 73446-1200
(580) 795-3301
(580) 795-7307
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA21084
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA12084
STATE OF FLORIDA
FL
Enumeration date
06/08/2010
Last updated
06/08/2010
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