MEDICARE: JESSICA L SMITH DPT

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	035408-1	NY

General Provider Information

NPI Number	:	1215285507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA L SMITH DPT

Provider Business Mailing Address
First Line	:	6221 STATE ROUTE 31
Second Line	:	SUITE 103
City	:	CICERO
State	:	NY
Zip	:	13039-8715
Country	:	US
Telephone Number	:	315-699-1009
Fax Number	:	315-699-1094

Provider Business Practice Location Address
First Line	:	6221 STATE ROUTE 31
Second Line	:	SUITE 103
City	:	CICERO
State	:	NY
Zip	:	13039-8715
Country	:	US
Telephone Number	:	315-699-1009
Fax Number	:	315-699-1094

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

Provider Enumeration Date	:	08/17/2012
Last Update Date	:	02/01/2016

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