Provider Demographics
NPI:1871692632
Name:SMITH, SCOTT ADAM (PT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ADAM
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:209 SAINT JAMES AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2998
Mailing Address - Country:US
Mailing Address - Phone:843-793-4466
Mailing Address - Fax:843-793-3786
Practice Address - Street 1:209 SAINT JAMES AVE STE 2B
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2998
Practice Address - Country:US
Practice Address - Phone:843-793-4466
Practice Address - Fax:843-793-3786
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT289772251X0800X
SC6304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT28977AMedicare ID - Type Unspecified