Healthcare Provider Details

I. General information

NPI: 1811452832
Provider Name (Legal Business Name): ZACHARY SMITH PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 DRIFTWOOD HILLS WAY
GEORGETOWN TX
78633-2184
US

IV. Provider business mailing address

104 DRIFTWOOD HILLS WAY
GEORGETOWN TX
78633-2184
US

V. Phone/Fax

Practice location:
  • Phone: 254-226-0588
  • Fax: 855-232-8604
Mailing address:
  • Phone: 254-226-0588
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1315529
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: