MEDICARE: MR. ALAN R SMITH PT

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	11-01524	KS

General Provider Information

NPI Number	:	1316924202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALAN R SMITH PT

Provider Business Mailing Address
First Line	:	1322 N WINDMILL RD
Second Line	:
City	:	DERBY
State	:	KS
Zip	:	67037-2841
Country	:	US
Telephone Number	:	316-788-4962
Fax Number	:

Provider Business Practice Location Address
First Line	:	728 N EMPORIA ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67214-3708
Country	:	US
Telephone Number	:	316-263-1952
Fax Number	:	316-263-4384

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	07/08/2007

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