Provider Demographics
NPI:1609264050
Name:SMITH, LARKIN C (MS, LAT, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:LARKIN
Middle Name:C
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 HARMONY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-9315
Mailing Address - Country:US
Mailing Address - Phone:803-528-1818
Mailing Address - Fax:
Practice Address - Street 1:4312 HARMONY CREEK RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9315
Practice Address - Country:US
Practice Address - Phone:803-528-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL41562255A2300X
SCATH11192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer