MEDICARE: DAN A SMITH

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	224Y00000X	Clinical Exercise Physiologist

General Provider Information

NPI Number	:	1881961514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAN A SMITH

Provider Business Mailing Address
First Line	:	807 CRESTLAND AVE
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2309
Country	:	US
Telephone Number	:	573-823-3352
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 CRESTLAND AVE
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-2309
Country	:	US
Telephone Number	:	573-823-3352
Fax Number	:

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

Provider Enumeration Date	:	11/23/2011
Last Update Date	:	11/23/2011

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Directions to “ DAN A SMITH ” Practice Location

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