MEDICARE: BRENT ANDREW SMITH DPT

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	118370	TX

General Provider Information

NPI Number	:	1447598230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT ANDREW SMITH DPT

Provider Business Mailing Address
First Line	:	1518 S PARK ST
Second Line	:
City	:	PECOS
State	:	TX
Zip	:	79772-5721
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 N ZARAGOZA RD
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-8004
Country	:	US
Telephone Number	:	915-562-8525
Fax Number	:

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

Provider Enumeration Date	:	01/29/2013
Last Update Date	:	01/29/2013

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Directions to “ BRENT ANDREW SMITH DPT” Practice Location

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