MEDICARE: TODD D 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	225100000X	Physical Therapist	PT22804	FL

General Provider Information

NPI Number	:	1598957672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD D SMITH MPT

Provider Business Mailing Address
First Line	:	743 NEWHALL ST E
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33974-9411
Country	:	US
Telephone Number	:	239-369-1755
Fax Number	:

Provider Business Practice Location Address
First Line	:	743 NEWHALL ST E
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33974-9411
Country	:	US
Telephone Number	:	239-369-1755
Fax Number	:

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

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	08/13/2007

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