Healthcare Provider Details

I. General information

NPI: 1184532673
Provider Name (Legal Business Name): SLATE PHYSICAL THERAPY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 WOODCREST AVE
BALTIMORE MD
21215-4029
US

IV. Provider business mailing address

390 NE 191ST ST STE 17221
MIAMI FL
33179-3899
US

V. Phone/Fax

Practice location:
  • Phone: 667-239-5010
  • Fax:
Mailing address:
  • Phone: 667-239-5010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RYAN MICHAEL SMITH
Title or Position: PRESIDENT
Credential: PT, DPT
Phone: 667-239-5010