Provider Demographics
NPI:1275840183
Name:SMITH PHYSICAL THERAPY & WELLNESS, P.C.
Entity Type:Organization
Organization Name:SMITH PHYSICAL THERAPY & WELLNESS, P.C.
Other - Org Name:KIM POLASEK, L.P.T., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KOBI
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-813-7142
Mailing Address - Street 1:202 GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:TX
Mailing Address - Zip Code:78390-2706
Mailing Address - Country:US
Mailing Address - Phone:361-528-3018
Mailing Address - Fax:361-528-3542
Practice Address - Street 1:202 GREEN AVE
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:TX
Practice Address - Zip Code:78390-2706
Practice Address - Country:US
Practice Address - Phone:361-528-3018
Practice Address - Fax:361-528-3542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX136226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0876815-01Medicaid