MEDICARE: RYAN E 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	PT2194	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08Y007824ME01	OTHER	ME	BC/BS OF NH
2	023200	OTHER	ME	BC/BS OF MAINE

General Provider Information

NPI Number	:	1316947146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN E SMITH PT

Provider Business Mailing Address
First Line	:	1900 LAFAYETTE RD
Second Line	:	SUITE C
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-5679
Country	:	US
Telephone Number	:	603-431-5600
Fax Number	:	603-431-5610

Provider Business Practice Location Address
First Line	:	1900 LAFAYETTE RD
Second Line	:	SUITE C
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-5679
Country	:	US
Telephone Number	:	603-431-5600
Fax Number	:	603-431-5610

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	03/07/2016

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Directions to “ RYAN E SMITH PT” Practice Location

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