MEDICARE: MR. GARY T SMITH MS, PT

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	3899	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881675874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY T SMITH MS, PT

Provider Business Mailing Address
First Line	:	2919 S ELLSWORTH RD
Second Line	:	STE 135
City	:	MESA
State	:	AZ
Zip	:	85212-2168
Country	:	US
Telephone Number	:	480-967-6888
Fax Number	:	480-967-6887

Provider Business Practice Location Address
First Line	:	3602 E GREENWAY RD
Second Line	:	STE 106
City	:	PHOENIX
State	:	AZ
Zip	:	85032-4648
Country	:	US
Telephone Number	:	602-643-0300
Fax Number	:	602-643-0038

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	02/02/2021

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