MEDICARE: SMART PHYSICAL THERAPY & WELLNESS LLC.

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

General Provider Information

NPI Number	:	1437916749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMART PHYSICAL THERAPY & WELLNESS LLC.

Provider Business Mailing Address
First Line	:	2945 STONE HOGAN RD STE 206
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2839
Country	:	US
Telephone Number	:	229-471-7225
Fax Number	:

Provider Business Practice Location Address
First Line	:	2945 STONE HOGAN RD STE 206
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2839
Country	:	US
Telephone Number	:	229-471-7225
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	LESLIE RANDALL SMART
Credential	:	DPT
Telephone Number	:	404-384-6520

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	03/04/2024

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