Provider Demographics
NPI:1023187812
Name:SMITH, GORDON FREDRICK II (MSPT)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:FREDRICK
Last Name:SMITH
Suffix:II
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2593 US HIGHWAY 2 E
Mailing Address - Street 2:SUITE 6
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-9507
Mailing Address - Country:US
Mailing Address - Phone:406-257-0933
Mailing Address - Fax:406-257-3426
Practice Address - Street 1:2593 US HIGHWAY 2 E
Practice Address - Street 2:SUITE 6
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-9507
Practice Address - Country:US
Practice Address - Phone:406-257-0933
Practice Address - Fax:406-257-3426
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT60466OtherBC BS
MT3400488Medicaid
MT150880200OtherDEPT OF LABOR
MT3400488Medicaid
000050692Medicare ID - Type Unspecified