MEDICARE: STACY L SMITH RPT

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	06756R	LA

General Provider Information

NPI Number	:	1689282691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY L SMITH RPT

Provider Business Mailing Address
First Line	:	2001 DOCTORS DR
Second Line	:
City	:	SPRINGHILL
State	:	LA
Zip	:	71075-4526
Country	:	US
Telephone Number	:	318-539-1000
Fax Number	:	318-539-4085

Provider Business Practice Location Address
First Line	:	206 REYNOLDS ST
Second Line	:
City	:	SPRINGHILL
State	:	LA
Zip	:	71075-3444
Country	:	US
Telephone Number	:	318-539-4006
Fax Number	:	318-539-4008

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

Provider Enumeration Date	:	07/15/2020
Last Update Date	:	07/15/2020

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Directions to “ STACY L SMITH RPT” Practice Location

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