Provider Demographics
NPI:1033556527
Name:SMITH, DENNIS GRAY (PTA)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:GRAY
Last Name:SMITH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 UNIVERSITY LAKE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4639
Mailing Address - Country:US
Mailing Address - Phone:907-561-8681
Mailing Address - Fax:
Practice Address - Street 1:6310 HABICHT CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1063
Practice Address - Country:US
Practice Address - Phone:907-276-2531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK834261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy