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General NPI Number Information
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NPI Number | 1760941306
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Entity Type | Individual
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Provider Name | NICHOLAS SMITH
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Gender | Male
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Dates
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Enumeration Date | 03/13/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 3745 PIAZZA DR APT 201
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City | FORT MYERS
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State | FL
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Zip | 33916-8134
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Country | US
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Telephone | 910-333-3386
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Fax |
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Provider Business Mailing Address
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Address Line | 3745 PIAZZA DR APT 201
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City | FORT MYERS
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State | FL
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Zip | 33916-8134
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Country | US
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Telephone |
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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 | PT33869
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License Number State | FL
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