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NPI Code Detail

MEDICARE: MEGAN JADE SMITH DPT

MEDICARE: MEGAN JADE 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
1225100000XPhysical Therapist5288OK

General Provider Information

NPI Number : 1487179693
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN JADE SMITH DPT
Provider Business Mailing Address
First Line : 1011 SAINT ANDREWS DR
Second Line :
City : EDMOND
State : OK
Zip : 73025-2646
Country : US
Telephone Number : 405-517-5556
Fax Number :
Provider Business Practice Location Address
First Line : 6500 N PORTLAND AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73116-2035
Country : US
Telephone Number : 405-767-6500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2017
Last Update Date : 03/17/2018

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