MEDICARE: DEANNA M 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	026010-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	388933	OTHER	NY	MVP

General Provider Information

NPI Number	:	1518979939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEANNA M SMITH P.T.

Provider Business Mailing Address
First Line	:	505 STATE ROUTE 208
Second Line	:	SUITE 30
City	:	MONROE
State	:	NY
Zip	:	10950-1608
Country	:	US
Telephone Number	:	845-782-3200
Fax Number	:	845-782-3100

Provider Business Practice Location Address
First Line	:	505 STATE ROUTE 208
Second Line	:	SUITE 30
City	:	MONROE
State	:	NY
Zip	:	10950-1608
Country	:	US
Telephone Number	:	845-782-3200
Fax Number	:	845-782-3100

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	09/21/2009

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Directions to “ DEANNA M SMITH P.T.” Practice Location

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