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General NPI Number Information
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NPI Number | 1821406125
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Entity Type | Organization
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Legal Business Name | SMD PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 07/30/2014
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Last Update Date | 07/30/2014
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Provider Practice Location Address
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Address Line | 2771 E BROAD ST STE 211
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City | MANSFIELD
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State | TX
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Zip | 76063-9157
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Country | US
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Telephone | 682-518-6263
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Fax | 682-325-3733
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Provider Business Mailing Address
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Address Line | 2771 E BROAD ST STE 211
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City | MANSFIELD
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State | TX
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Zip | 76063-9157
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Country | US
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Telephone | 682-518-6263
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Fax | 682-325-3733
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHAUNA DACUS
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Credential | PT
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Telephone | 214-801-9557
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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 | 1179278
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License Number State | TX
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