Healthcare Provider Details

I. General information

NPI: 1477684090
Provider Name (Legal Business Name): STEVEN DANIEL SMITH P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N WESTERN AVE
LAKE FOREST IL
60045-1282
US

IV. Provider business mailing address

38394 N BURR OAK LN
WADSWORTH IL
60083-9546
US

V. Phone/Fax

Practice location:
  • Phone: 847-234-0404
  • Fax:
Mailing address:
  • Phone: 847-782-8430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: