Provider Demographics
NPI:1679853907
Name:SMITH, BENJAMIN LEVI (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:LEVI
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 1:2918 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0064
Mailing Address - Country:US
Mailing Address - Phone:903-628-1214
Mailing Address - Fax:903-347-2255
Practice Address - Street 1:2918 PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0064
Practice Address - Country:US
Practice Address - Phone:903-793-6135
Practice Address - Fax:903-793-0053
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1192873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX880761OtherUNITED HEALTHCARE
AR88219OtherBCBS
TX13572986OtherHEALTHSMART
AR192589721Medicaid
ARP14919OtherSUPERIOR
TX00038458OtherCHRISTUS HEALTH PLAN
ARB0003814OtherEMPOWER
TX2720894OtherFIRST HEALTH
TX4842988OtherAETNA
TX1314540OtherCIGNA AMERICAN SPECIALTY HEALTH
TX287333301Medicaid
TX721253100OtherDEPARTMENT OF LABOR