MEDICARE: MR. NIGEL DAVID 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	1087252	TX

General Provider Information

NPI Number	:	1932325826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NIGEL DAVID SMITH P.T.

Provider Business Mailing Address
First Line	:	9815 VISTADALE DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-1529
Country	:	US
Telephone Number	:	214-221-8608
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 GASTON AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75246-2018
Country	:	US
Telephone Number	:	214-820-9376
Fax Number	:

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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