MEDICARE: CHRISTAL SMITH

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	172M00000X	Mechanotherapist	NVMT.150	NV

General Provider Information

NPI Number	:	1356614317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTAL SMITH

Provider Business Mailing Address
First Line	:	1207 SMOKE TREE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1069
Country	:	US
Telephone Number	:	702-340-2278
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 SMOKE TREE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1069
Country	:	US
Telephone Number	:	702-340-2278
Fax Number	:

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

Provider Enumeration Date	:	02/21/2012
Last Update Date	:	02/21/2012

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Directions to “ CHRISTAL SMITH ” Practice Location

Language	Start Address	Practice Location

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