Healthcare Provider Details

I. General information

NPI: 1750087524
Provider Name (Legal Business Name): JUSTIN SMITH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 N KLEIN CIR
DERBY KS
67037-7011
US

IV. Provider business mailing address

731 N KLEIN CIR
DERBY KS
67037-7011
US

V. Phone/Fax

Practice location:
  • Phone: 316-719-2400
  • Fax:
Mailing address:
  • Phone: 316-719-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number11-06331
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: