MEDICARE: GEORGIA L. SMITH PT

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	1006666	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T4562	OTHER	TX	BLUE SHIELD

General Provider Information

NPI Number	:	1063475325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGIA L. SMITH PT

Provider Business Mailing Address
First Line	:	PO BOX 847556
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7556
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 N HEWITT DR
Second Line	:
City	:	HEWITT
State	:	TX
Zip	:	76643-3038
Country	:	US
Telephone Number	:	254-666-3666
Fax Number	:

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

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	07/11/2007

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Directions to “ GEORGIA L. SMITH PT” Practice Location

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