Healthcare Provider Details

I. General information

NPI: 1386633972
Provider Name (Legal Business Name): BRIAN D SMITH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N PERIMETER RD
GREAT FALLS MT
59402-6701
US

IV. Provider business mailing address

3226 2ND AVE S
GREAT FALLS MT
59405-3322
US

V. Phone/Fax

Practice location:
  • Phone: 406-731-4456
  • Fax:
Mailing address:
  • Phone: 505-908-6164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5851
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: