Healthcare Provider Details

I. General information

NPI: 1932678406
Provider Name (Legal Business Name): JAMES EDWARD SMITH PT,DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 PA-113 #6
SOUDERTON PA
18964
US

IV. Provider business mailing address

723 ROUTE 113 # 6
SOUDERTON PA
18964-1000
US

V. Phone/Fax

Practice location:
  • Phone: 215-538-1999
  • Fax:
Mailing address:
  • Phone: 215-962-1720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT027376
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: