MEDICARE: CLARENCE SMITH LMT

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	225700000X	Massage Therapist	MT-25936	AZ

General Provider Information

NPI Number	:	1548853385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARENCE SMITH LMT

Provider Business Mailing Address
First Line	:	3727 W FRIER DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6477
Country	:	US
Telephone Number	:	623-332-1665
Fax Number	:

Provider Business Practice Location Address
First Line	:	3727 W FRIER DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-6477
Country	:	US
Telephone Number	:	623-332-1665
Fax Number	:

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

Provider Enumeration Date	:	02/12/2021
Last Update Date	:	02/12/2021

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Directions to “ CLARENCE SMITH LMT” Practice Location

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