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NPI Code Detail

MEDICARE: PEGGY A SMITH B.P.T.

MEDICARE: PEGGY A SMITH B.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
1225100000XPhysical Therapist336WY
2225100000XPhysical Therapist2110AZ
3225100000XPhysical Therapist806ND
4225100000XPhysical Therapist0336SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24992796OTHERSDBLUE CROSS BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1275727745
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEGGY A SMITH B.P.T.
Provider Business Mailing Address
First Line : 520 N CANYON ST
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-2320
Country : US
Telephone Number : 605-642-7996
Fax Number : 605-642-5955
Provider Business Practice Location Address
First Line : 520 N CANYON ST
Second Line :
City : SPEARFISH
State : SD
Zip : 57783-2320
Country : US
Telephone Number : 605-642-7996
Fax Number : 605-642-5955
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2007
Last Update Date : 08/28/2008

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1104025907 — MATTHEW SCOTT WEIGEL PT
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1760891923 — JENS K MATSON PT. DPT, OCS, CMPT
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Directions to “ PEGGY A SMITH B.P.T.” Practice Location

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