MEDICARE: TRACY L. SMILES M.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	5501011378	MI

General Provider Information

NPI Number	:	1093812950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY L. SMILES M.P.T.

Provider Business Mailing Address
First Line	:	33900 HARPER AVE STE 104
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48035-4258
Country	:	US
Telephone Number	:	586-416-9100
Fax Number	:	586-416-9103

Provider Business Practice Location Address
First Line	:	1467 E 12 MILE RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071-2653
Country	:	US
Telephone Number	:	248-658-2110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/22/2026

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