Provider Demographics
NPI:1679600548
Name:SMITH, DAVID LAURENCE (PT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAURENCE
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 GOOSE ROCKS RD
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04046-5102
Mailing Address - Country:US
Mailing Address - Phone:207-286-6962
Mailing Address - Fax:
Practice Address - Street 1:283 GOOSE ROCKS RD
Practice Address - Street 2:
Practice Address - City:KENNEBUNKPORT
Practice Address - State:ME
Practice Address - Zip Code:04046-5102
Practice Address - Country:US
Practice Address - Phone:207-229-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1902174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist