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General NPI Number Information
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NPI Number | 1861869026
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Entity Type | Individual
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Provider Name | ADAM SMITH P.T., D.P.T., CSCS
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Gender | Male
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 04/20/2016
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Provider Practice Location Address
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Address Line | 2885 10 MILE RD NE
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City | ROCKFORD
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State | MI
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Zip | 49341-9177
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Country | US
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Telephone | 616-866-6300
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Fax |
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Provider Business Mailing Address
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Address Line | 2025 E WYNDHAM HILL DR NE APT 204
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-7106
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Country | US
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Telephone | 517-648-8869
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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 | 42941
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501017646
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License Number State | MI
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