MEDICARE: STEPHANIE 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	12434-024	WI

General Provider Information

NPI Number	:	1215344718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SMITH DPT

Provider Business Mailing Address
First Line	:	8677 N PORT WASHINGTON RD
Second Line	:
City	:	FOX POINT
State	:	WI
Zip	:	53217-2209
Country	:	US
Telephone Number	:	414-351-8482
Fax Number	:	414-351-8483

Provider Business Practice Location Address
First Line	:	8677 N PORT WASHINGTON RD
Second Line	:
City	:	FOX POINT
State	:	WI
Zip	:	53217-2209
Country	:	US
Telephone Number	:	414-351-8482
Fax Number	:	414-351-8483

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

Provider Enumeration Date	:	07/16/2014
Last Update Date	:	07/30/2015

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