=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730120940
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES M SMITH PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2006
-----------------------------------------------------
Last Update Date | 02/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1904 ATLANTIC AVENUE
-----------------------------------------------------
City | MANASQUAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08736-1006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-528-1010
-----------------------------------------------------
Fax | 732-528-2139
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 66 W GILBERT ST SUITE 100
-----------------------------------------------------
City | RED BANK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701-4918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-212-0060
-----------------------------------------------------
Fax | 732-212-0061
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 40QA00665400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 0150041
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------