Provider Demographics
NPI:1093927485
Name:SMITH, DAVID ALLAN (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 N CINCH RING
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-5703
Mailing Address - Country:US
Mailing Address - Phone:906-551-7580
Mailing Address - Fax:
Practice Address - Street 1:588 N CINCH RING
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:AZ
Practice Address - Zip Code:86327-5703
Practice Address - Country:US
Practice Address - Phone:906-551-7580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-06
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 17081225100000X
AZ31781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist