MEDICARE: MRS. JANET M. 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	003275	CT

General Provider Information

NPI Number	:	1396781092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANET M. SMITH PT

Provider Business Mailing Address
First Line	:	500 E MAIN ST
Second Line	:	SUITE 310
City	:	BRANFORD
State	:	CT
Zip	:	06405-2911
Country	:	US
Telephone Number	:	203-315-7727
Fax Number	:	203-315-7757

Provider Business Practice Location Address
First Line	:	500 E MAIN ST
Second Line	:	STE 310
City	:	BRANFORD
State	:	CT
Zip	:	06405-2911
Country	:	US
Telephone Number	:	203-315-7727
Fax Number	:	203-315-7757

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	10/18/2010

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