Provider Demographics
NPI:1639899644
Name:SMITH, RYAN MATHEW (PT, DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MATHEW
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 HINSON LOOP RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-3903
Mailing Address - Country:US
Mailing Address - Phone:501-301-4530
Mailing Address - Fax:
Practice Address - Street 1:1909 HINSON LOOP RD STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212-3903
Practice Address - Country:US
Practice Address - Phone:501-301-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5213225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist