Provider Demographics
NPI:1376796870
Name:SMITH, ERIC C (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:C
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6705 E 81ST ST STE 170
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4171
Mailing Address - Country:US
Mailing Address - Phone:918-710-5790
Mailing Address - Fax:918-728-2217
Practice Address - Street 1:6705 E 81ST ST STE 170
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4171
Practice Address - Country:US
Practice Address - Phone:918-710-5790
Practice Address - Fax:918-728-2217
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist