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General NPI Number Information
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NPI Number | 1285955104
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Entity Type | Individual
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Provider Name | SCOTT STUART SMITH PT
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Gender | Male
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Dates
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Enumeration Date | 06/15/2010
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 507 W DOUGHTY ST
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City | LAKE CITY
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State | MN
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Zip | 55041-1500
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Country | US
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Telephone | 651-345-2350
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Fax | 651-345-2238
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Provider Business Mailing Address
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Address Line | 507 W DOUGHTY ST
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City | LAKE CITY
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State | MN
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Zip | 55041-1500
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Country | US
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Telephone | 651-345-2350
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Fax | 651-345-2238
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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 | 2305210973
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9547
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License Number State | MN
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