MEDICARE: DAVID 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	225100000X	Physical Therapist	J1-0004025	DE
2	225100000X	Physical Therapist	28369	MD

General Provider Information

NPI Number	:	1407320880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID SMITH

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2540 PULASKI HWY STE B
Second Line	:
City	:	NORTH EAST
State	:	MD
Zip	:	21901-2610
Country	:	US
Telephone Number	:	410-339-1960
Fax Number	:	443-941-9441

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

Provider Enumeration Date	:	01/18/2019
Last Update Date	:	12/30/2024

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Directions to “ DAVID SMITH ” Practice Location

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