Individual
HALEY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
733 DUNLAWTON AVE, PORT ORANGE, FL 32127-4225
(386) 756-0077
Mailing address
709 RIDGE BLVD, SOUTH DAYTONA, FL 32119-2839
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA28085
FL
Other
Enumeration date
12/13/2017
Last updated
12/13/2017
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