Healthcare Provider Details

I. General information

NPI: 1205979648
Provider Name (Legal Business Name): DONALD LEA SMITH PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7242 BAILEY COVE RD SE
HUNTSVILLE AL
35802-2746
US

IV. Provider business mailing address

8059 MITCHELL LN
VESTAVIA HILLS AL
35216-6821
US

V. Phone/Fax

Practice location:
  • Phone: 205-478-4418
  • Fax:
Mailing address:
  • Phone: 205-478-4418
  • Fax: 205-478-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH4989
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: