Healthcare Provider Details

I. General information

NPI: 1568382323
Provider Name (Legal Business Name): JONATHAN RYAN SMITH PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 CLUB LN STE 2
CONWAY AR
72034-3681
US

IV. Provider business mailing address

1435 GARDENIA
CONWAY AR
72034-8495
US

V. Phone/Fax

Practice location:
  • Phone: 501-932-0814
  • Fax: 501-932-0819
Mailing address:
  • Phone: 501-932-0814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3133
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: