MEDICARE: ALEXANDER 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

General Provider Information

NPI Number	:	1487286704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDER SMITH

Provider Business Mailing Address
First Line	:	50492 AMBERLEY BLVD
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48187-4443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2455 UNION LAKE RD STE 104
Second Line	:
City	:	COMMERCE TWP
State	:	MI
Zip	:	48382-3596
Country	:	US
Telephone Number	:	248-353-1234
Fax Number	:	248-353-1211

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

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	02/05/2020

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Directions to “ ALEXANDER SMITH ” Practice Location

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