MEDICARE: COOPER 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	225100000X	Physical Therapist	14266676-2401	UT

General Provider Information

NPI Number	:	1740131796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COOPER SMITH

Provider Business Mailing Address
First Line	:	524 W 300 N STE 201
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84601-2669
Country	:	US
Telephone Number	:	801-940-5092
Fax Number	:

Provider Business Practice Location Address
First Line	:	524 W 300 N STE 201
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84601-2669
Country	:	US
Telephone Number	:	801-940-5092
Fax Number	:

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

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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Directions to “ COOPER SMITH ” Practice Location

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