Provider Demographics
NPI:1730610122
Name:SMITH, KARLA M (PTA)
Entity type:Individual
Prefix:MS
First Name:KARLA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 COMMERCE DR
Mailing Address - Street 2:UNIT 3-201
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-7151
Mailing Address - Country:US
Mailing Address - Phone:781-626-0488
Mailing Address - Fax:
Practice Address - Street 1:501 COMMERCE DR
Practice Address - Street 2:UNIT 3-201
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-7151
Practice Address - Country:US
Practice Address - Phone:781-626-0488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6247225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant