Healthcare Provider Details

I. General information

NPI: 1174863856
Provider Name (Legal Business Name): ERIC MONROE SMITH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 03/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5796 NASHVILLE RD
BOWLING GREEN KY
42101-7546
US

IV. Provider business mailing address

836 ROCKWOOD DR
BOWLING GREEN KY
42103-1562
US

V. Phone/Fax

Practice location:
  • Phone: 270-745-0987
  • Fax: 270-745-0986
Mailing address:
  • Phone: 270-282-5142
  • Fax: 270-745-0986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-001775
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: