Provider Demographics
NPI:1598846396
Name:SMITH, BRITT MATTHEW (MSPT, OCS)
Entity Type:Individual
Prefix:MR
First Name:BRITT
Middle Name:MATTHEW
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2497 POWER RD UNIT 10
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-3085
Mailing Address - Country:US
Mailing Address - Phone:970-263-4079
Mailing Address - Fax:970-241-2595
Practice Address - Street 1:2497 POWER RD UNIT 10
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81507-3085
Practice Address - Country:US
Practice Address - Phone:970-263-4079
Practice Address - Fax:970-241-2595
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50922251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO8803Medicare ID - Type Unspecified