Provider Demographics
NPI:1083261978
Name:SMITH, SAMUEL WRIGHT (DPT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:WRIGHT
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 S GLENN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-3708
Mailing Address - Country:US
Mailing Address - Phone:316-210-1529
Mailing Address - Fax:
Practice Address - Street 1:6803 W TAFT AVE STE 303
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-2365
Practice Address - Country:US
Practice Address - Phone:316-347-7969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-25
Last Update Date:2019-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06280225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist