MEDICARE: ROY M SMITH 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	3108	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	07924	OTHER	NC	BCBS
2	110441	OTHER	NC	WELLNESS
3	294088	OTHER	NC	MAMSI
4	88728	OTHER	NC	MEDCOST
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861409260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROY M SMITH PT

Provider Business Mailing Address
First Line	:	1100 BLYTHE BLVD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-5814
Country	:	US
Telephone Number	:	704-355-4370
Fax Number	:	704-355-4231

Provider Business Practice Location Address
First Line	:	1408 EAST BLVD
Second Line	:	B#2
City	:	CHARLOTTE
State	:	NC
Zip	:	28203-6103
Country	:	US
Telephone Number	:	704-355-8100
Fax Number	:	704-355-8127

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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Directions to “ ROY M SMITH PT” Practice Location

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