Healthcare Provider Details

I. General information

NPI: 1427244805
Provider Name (Legal Business Name): BRIAN JOSEPH SMITH L.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 SIDELINE RD
QUAKERTOWN PA
18951-3331
US

IV. Provider business mailing address

1704 SIDELINE RD
QUAKERTOWN PA
18951-3331
US

V. Phone/Fax

Practice location:
  • Phone: 610-393-3977
  • Fax:
Mailing address:
  • Phone: 610-393-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007958L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: