MEDICARE: DR. BLAKE C SMITH DPT

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	:	1639806755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAKE C SMITH DPT

Provider Business Mailing Address
First Line	:	4 OKATIE CENTER BLVD S STE 101
Second Line	:
City	:	OKATIE
State	:	SC
Zip	:	29909-7530
Country	:	US
Telephone Number	:	843-705-9480
Fax Number	:	843-705-9481

Provider Business Practice Location Address
First Line	:	4 OKATIE CENTER BLVD S STE 101
Second Line	:
City	:	OKATIE
State	:	SC
Zip	:	29909-7530
Country	:	US
Telephone Number	:	843-705-9480
Fax Number	:	843-705-9481

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

Provider Enumeration Date	:	08/08/2022
Last Update Date	:	08/08/2022

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Directions to “ DR. BLAKE C SMITH DPT” Practice Location

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