MEDICARE: GWENDOLYN KAY SMITH P.T.

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	21873	MD

General Provider Information

NPI Number	:	1508875493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN KAY SMITH P.T.

Provider Business Mailing Address
First Line	:	EVANS ARMY COMMUNITY HOSPITAL
Second Line	:	1650 COCHRANE CIR BLDG7500
City	:	FT CARSON
State	:	CO
Zip	:	80913
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	EVANS ARMY COMMUNITY HOSPITAL
Second Line	:	1650 COCHRANE CIR BLDG7500
City	:	FT CARSON
State	:	CO
Zip	:	80913
Country	:	US
Telephone Number	:	719-524-6616
Fax Number	:

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	06/11/2026

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