MEDICARE: PROF. MARCIA B SMITH PHD, 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	PTL-603	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PTL-603	OTHER	CO	PHYSICAL THERAPY

General Provider Information

NPI Number	:	1952509226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. MARCIA B SMITH PHD, PT

Provider Business Mailing Address
First Line	:	3333 REGIS BLVD
Second Line	:	MAIL CODE G-4
City	:	DENVER
State	:	CO
Zip	:	80221-1154
Country	:	US
Telephone Number	:	303-964-5306
Fax Number	:	303-964-5474

Provider Business Practice Location Address
First Line	:	3333 REGIS BLVD
Second Line	:	MAIL CODE G-4
City	:	DENVER
State	:	CO
Zip	:	80221-1154
Country	:	US
Telephone Number	:	303-964-5306
Fax Number	:	303-964-5474

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

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	07/08/2007

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