Basic Information
| Provider Information | |||||||||
| NPI: | 1144577222 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | DIONNDRA | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 BRANTLEY ROAD #905 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339073994 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2566032826 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1750 WILCO RD | ||||||||
| Address2: | |||||||||
| City: | STAYTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973831085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5037697131 | ||||||||
| FaxNumber: | 5037697132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2012 | ||||||||
| LastUpdateDate: | 06/27/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1272898 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT27133 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 63310 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.