Provider Demographics
NPI:1104045764
Name:SMITH, MARY REBECCA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:REBECCA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7908 WOOD DUCK DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-3331
Mailing Address - Country:US
Mailing Address - Phone:405-659-2003
Mailing Address - Fax:405-948-2807
Practice Address - Street 1:4350 WILL ROGERS PKWY STE 600
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1808
Practice Address - Country:US
Practice Address - Phone:405-948-2813
Practice Address - Fax:405-948-2807
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist