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General NPI Number Information
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NPI Number | 1679577050
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Entity Type | Individual
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Provider Name | JUSTIN RYAN SMALLWOOD PT
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Gender | Male
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 1506 S SUNSET AVE
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City | LITTLEFIELD
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State | TX
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Zip | 79339-4899
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Country | US
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Telephone | 806-385-3746
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Fax |
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Provider Business Mailing Address
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Address Line | 2431 S LOOP 289
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City | LUBBOCK
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State | TX
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Zip | 79423-1519
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Country | US
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Telephone | 806-771-8008
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Fax | 806-771-8009
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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 | PT1113686
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License Number State | TX
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