Provider Demographics
NPI:1477660488
Name:SMART INSTITUTE
Entity Type:Organization
Organization Name:SMART INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAVOMALO
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:817-377-3422
Mailing Address - Street 1:3600 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2534
Mailing Address - Country:US
Mailing Address - Phone:817-377-3422
Mailing Address - Fax:817-735-8615
Practice Address - Street 1:3600 W 7TH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-2534
Practice Address - Country:US
Practice Address - Phone:817-377-3422
Practice Address - Fax:817-735-8615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1067213225100000X
TX1115103225100000X
TX1142016225100000X
TX1142990225100000X
TX109562225X00000X
TX101365235Z00000X
TX102607235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty