=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740762988
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN NICOLE SMITH PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2018
-----------------------------------------------------
Last Update Date | 01/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10721 RESEARCH BLVD STE 150A
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78759-6062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-481-9964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2102 HIGHGROVE TER
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78703-4500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-269-4816
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 1309080
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------