MEDICARE: SMITH & PROTHERO PHYSICAL THERAPY LLC

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	2251X0800X	Orthopedic Physical Therapist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB2775	OTHER	MD	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	LS73SM	OTHER	MD	CAREFIRST BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942200621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMITH & PROTHERO PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	807A S UNION AVE
Second Line	:
City	:	HAVRE DE GRACE
State	:	MD
Zip	:	21078-3610
Country	:	US
Telephone Number	:	410-939-2262
Fax Number	:	410-939-7119

Provider Business Practice Location Address
First Line	:	807A S UNION AVE
Second Line	:
City	:	HAVRE DE GRACE
State	:	MD
Zip	:	21078-3610
Country	:	US
Telephone Number	:	410-939-2262
Fax Number	:	410-939-7119

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. WILLIAM CHARLES SMITH
Credential	:	PT
Telephone Number	:	410-939-2262

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	10/09/2020

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Directions to “SMITH & PROTHERO PHYSICAL THERAPY LLC ” Practice Location

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