Basic Information
| Provider Information | |||||||||
| NPI: | 1114193794 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 S 14TH ST | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 590473731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062220672 | ||||||||
| FaxNumber: | 4062221406 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 S 14TH ST | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 590473731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062220672 | ||||||||
| FaxNumber: | 4062221406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2008 | ||||||||
| LastUpdateDate: | 05/05/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 1465PTA | MT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.