Healthcare Provider Details

I. General information

NPI: 1205423167
Provider Name (Legal Business Name): TIMOTHY WILLIAM SMITH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 OLMSTED BLVD STE B
PINEHURST NC
28374-6003
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 910-235-0655
  • Fax:
Mailing address:
  • Phone: 423-702-4389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP23677
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: