Healthcare Provider Details

I. General information

NPI: 1043413263
Provider Name (Legal Business Name): SCOT SMITH P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38777 WEST 6 MILE RD SUITE 209
LIVONIA MI
48152
US

IV. Provider business mailing address

4891 MACERI CIR
STERLING HEIGHTS MI
48314-4074
US

V. Phone/Fax

Practice location:
  • Phone: 888-414-7056
  • Fax:
Mailing address:
  • Phone: 586-839-9537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501010307
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number8288
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: