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General NPI Number Information
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NPI Number | 1063570554
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Entity Type | Individual
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Provider Name | JAMES C SMITH RPT
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10500 WAYZATA BLVD
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City | MINNETONKA
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State | MN
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Zip | 55305-1511
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Country | US
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Telephone | 952-545-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 16494 ASHBY LN
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City | EDEN PRAIRIE
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State | MN
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Zip | 55346-1406
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Country | US
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Telephone | 952-949-0326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2576
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License Number State | MN
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