MEDICARE: DILLON SMITH PT, DPT

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	1330431	TX

General Provider Information

NPI Number	:	1992312482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DILLON SMITH PT, DPT

Provider Business Mailing Address
First Line	:	6012 ALTOMONTE DR APT 438
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-5406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6621 DAN DANCIGER RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4905
Country	:	US
Telephone Number	:	979-268-2462
Fax Number	:

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

Provider Enumeration Date	:	09/28/2020
Last Update Date	:	09/28/2020

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Directions to “ DILLON SMITH PT, DPT” Practice Location

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