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General NPI Number Information
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NPI Number | 1659400026
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Entity Type | Individual
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Provider Name | SYLVIA M SMISER PT
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Gender | Female
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Dates
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Enumeration Date | 03/03/2007
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Last Update Date | 11/23/2018
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Provider Practice Location Address
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Address Line | 924 W CUSTER AVE
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City | PONTIAC
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State | IL
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Zip | 61764-1067
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Country | US
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Telephone | 815-844-4690
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 FORT JESSE RD STE 250
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City | NORMAL
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State | IL
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Zip | 61761-6290
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Country | US
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Telephone | 815-844-4690
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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 | 070014908
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License Number State | IL
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