MEDICARE: KIARA SMITH PT, DPT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	30794	MD
2	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1013481662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIARA SMITH PT, DPT, ATC

Provider Business Mailing Address
First Line	:	5830 GRANITE PKWY STE 800
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-6775
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12070 OLD LINE CTR STE 107
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602-2503
Country	:	US
Telephone Number	:	301-374-6885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2019
Last Update Date	:	03/16/2026

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