MEDICARE: ANJORAY SMITH MPT

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	174400000X	Specialist	PT-008539-L	PA
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1548310956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANJORAY SMITH MPT

Provider Business Mailing Address
First Line	:	PO BOX 689022
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-9022
Country	:	US
Telephone Number	:	615-778-8384
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 W LINFIELD TRAPPE RD BLDG A
Second Line	:	SUITE 2000
City	:	LIMERICK
State	:	PA
Zip	:	19468-4278
Country	:	US
Telephone Number	:	610-495-0095
Fax Number	:

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	02/02/2017

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