MEDICARE: MISS AMY M SMITH P.T.

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	016696	NY

General Provider Information

NPI Number	:	1811169758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AMY M SMITH P.T.

Provider Business Mailing Address
First Line	:	711 TROY SCHENECTADY RD
Second Line	:	SUITE 203
City	:	LATHAM
State	:	NY
Zip	:	12110-2442
Country	:	US
Telephone Number	:	518-213-0478
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 ROUTE 9
Second Line	:	SUITE 101
City	:	CLIFTON PARK
State	:	NY
Zip	:	12065-2421
Country	:	US
Telephone Number	:	518-373-2042
Fax Number	:

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

Provider Enumeration Date	:	04/01/2008
Last Update Date	:	08/24/2010

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