MEDICARE: DR. CASEY M SMITH PT, DPT, CSCS, WCS

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	037037	NY

General Provider Information

NPI Number	:	1548678444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASEY M SMITH PT, DPT, CSCS, WCS

Provider Business Mailing Address
First Line	:	9211 FOREST HILL AVE STE 103
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-6874
Country	:	US
Telephone Number	:	804-985-1234
Fax Number	:	833-389-1702

Provider Business Practice Location Address
First Line	:	9211 FOREST HILL AVE STE 103
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-6874
Country	:	US
Telephone Number	:	804-985-1234
Fax Number	:

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

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	11/14/2023

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