Healthcare Provider Details

I. General information

NPI: 1093927485
Provider Name (Legal Business Name): DAVID ALLAN SMITH P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 N CINCH RING
DEWEY AZ
86327-5703
US

IV. Provider business mailing address

588 N CINCH RING
DEWEY AZ
86327-5703
US

V. Phone/Fax

Practice location:
  • Phone: 906-551-7580
  • Fax:
Mailing address:
  • Phone: 906-551-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 17081
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number31781
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: