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NPI Code Detail

MEDICARE: MACY NESMITH PT, DPT

MEDICARE: MACY NESMITH PT, 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
1225100000XPhysical Therapist1274432TX

General Provider Information

NPI Number : 1265984496
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACY NESMITH PT, DPT
Provider Business Mailing Address
First Line : 101 N ROARING SPRINGS RD
Second Line : APT 1209
City : WESTWORTH VILLAGE
State : TX
Zip : 76114-3506
Country : US
Telephone Number : 214-957-9727
Fax Number :
Provider Business Practice Location Address
First Line : 250 SANTA FE DR
Second Line :
City : WEATHERFORD
State : TX
Zip : 76086-6585
Country : US
Telephone Number : 817-550-5058
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2016
Last Update Date : 11/04/2016

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