MEDICARE: MS. SHAUNA FORSYTH SMITH P.T.

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	1713	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1992744429	OTHER		NPI

General Provider Information

NPI Number	:	1992744429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHAUNA FORSYTH SMITH P.T.

Provider Business Mailing Address
First Line	:	6451 N COLUMBUS BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-2504
Country	:	US
Telephone Number	:	520-977-3383
Fax Number	:

Provider Business Practice Location Address
First Line	:	2560 E FORT LOWELL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1514
Country	:	US
Telephone Number	:	520-323-9086
Fax Number	:

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	09/17/2010

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