MEDICARE: SPENSER PETE 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	PTL.0020819	CO

General Provider Information

NPI Number	:	1427908912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENSER PETE SMITH

Provider Business Mailing Address
First Line	:	10670 JAKE JABS BLVD APT 2207
Second Line	:
City	:	FIRESTONE
State	:	CO
Zip	:	80504-5996
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 E KEN PRATT BLVD # 80504
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80504-5311
Country	:	US
Telephone Number	:	720-718-1310
Fax Number	:

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

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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