MEDICARE: PETER LLOYD SMITH II MS PT

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT19471	OTHER	FL	LICENSE #

General Provider Information

NPI Number	:	1437268000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER LLOYD SMITH II MS PT

Provider Business Mailing Address
First Line	:	4807 SW 195TH TER
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33029-6208
Country	:	US
Telephone Number	:	954-436-7046
Fax Number	:

Provider Business Practice Location Address
First Line	:	3325 HOLLYWOOD BLVD STE 200
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6926
Country	:	US
Telephone Number	:	954-986-2299
Fax Number	:

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	08/28/2019

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