MEDICARE: LAURIE SMITH

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	225200000X	Physical Therapy Assistant	5502001062	MI

General Provider Information

NPI Number	:	1700385465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE SMITH

Provider Business Mailing Address
First Line	:	1525 PARK AVE
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-5532
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 PARK AVE
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-5532
Country	:	US
Telephone Number	:	989-460-7953
Fax Number	:

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

Provider Enumeration Date	:	02/08/2018
Last Update Date	:	02/08/2018

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Directions to “ LAURIE SMITH ” Practice Location

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