Active NPI
Providencia Acabeo-Smith, P.T.
- Physical Therapist
- Summersville, WV
National Provider Identifier
1235264466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 001172
- Practice address
- 704 Professional Park Dr
Suite B
Summersville, WV 26651-2000 - Phone
- (304) 872-0490
- Fax
- (304) 872-0492
- NPI assigned
- Feb 21, 2007
- Last updated
- Jul 29, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 001172 | WV | Primary |
Addresses
Primary practice location
704 Professional Park Dr
Suite B
Summersville, WV 26651-2000
Mailing address
704 Professional Park Dr
Suite B
Summersville, WV 26651-2000
Phone (304) 872-0490
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0157391000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001172 | WV | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172016000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217289600000",
"number": "1235264466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "704 PROFESSIONAL PARK DR",
"address_2": "SUITE B",
"city": "SUMMERSVILLE",
"state": "WV",
"postal_code": "266512000",
"telephone_number": "304-872-0490",
"fax_number": "304-872-0492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "704 PROFESSIONAL PARK DR",
"address_2": "SUITE B",
"city": "SUMMERSVILLE",
"state": "WV",
"postal_code": "266512000",
"telephone_number": "304-872-0490",
"fax_number": "304-872-0492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ACABEO-SMITH",
"first_name": "PROVIDENCIA",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-21",
"last_updated": "2008-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "001172",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0157391000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Summersville, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.