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NPI Code Detail

MEDICARE: ALONZO SMITH

MEDICARE:   ALONZO  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
1225100000XPhysical TherapistTE007422PA

General Provider Information

NPI Number : 1467641050
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALONZO SMITH
Provider Business Mailing Address
First Line : 7522 BROCKTON RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19151-2825
Country : US
Telephone Number : 215-877-5962
Fax Number :
Provider Business Practice Location Address
First Line : 305 CHERRY ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19106-1803
Country : US
Telephone Number : 215-877-5962
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2007
Last Update Date : 10/18/2007

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Directions to “ ALONZO SMITH ” Practice Location

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