MEDICARE: MS. TANYA MARIE SMITH PT SCD COMT

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	2087	AK

General Provider Information

NPI Number	:	1821102864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TANYA MARIE SMITH PT SCD COMT

Provider Business Mailing Address
First Line	:	2309 E 20TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-3212
Country	:	US
Telephone Number	:	907-279-4266
Fax Number	:	907-279-4272

Provider Business Practice Location Address
First Line	:	1917 ABBOTT RD
Second Line	:	STE 200
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-3448
Country	:	US
Telephone Number	:	907-279-4266
Fax Number	:	907-279-4272

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	10/07/2009

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