MEDICARE: PIETER DE SMIDT P.T.

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	1072643	TX

General Provider Information

NPI Number	:	1174612527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PIETER DE SMIDT P.T.

Provider Business Mailing Address
First Line	:	1045 CENTRAL PARKWAY NORTH
Second Line	:	SUITE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-5024
Country	:	US
Telephone Number	:	210-541-4500
Fax Number	:	210-541-4508

Provider Business Practice Location Address
First Line	:	2235 THOUSAND OAKS DR
Second Line	:	SUITE 118
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3969
Country	:	US
Telephone Number	:	210-402-3856
Fax Number	:	210-490-5921

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	05/10/2016

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