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General NPI Number Information
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NPI Number | 1467157750
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Entity Type | Individual
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Provider Name | BENNETT SMITH DPT, PT
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Gender | Male
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Dates
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Enumeration Date | 04/04/2023
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Last Update Date | 04/04/2023
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Provider Practice Location Address
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Address Line | 110 SC-225
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City | GREENWOOD
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State | SC
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Zip | 29646
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Country | US
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Telephone | 864-223-0406
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Fax |
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Provider Business Mailing Address
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Address Line | 6611 MERRILL RD
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City | COLUMBIA
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State | SC
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Zip | 29209-2057
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Country | US
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Telephone | 910-916-9957
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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 | 11804
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License Number State | SC
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