Provider Demographics
NPI:1710486071
Name:SMITH, DAVID PARRISH
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PARRISH
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1071
Mailing Address - Country:US
Mailing Address - Phone:248-635-5848
Mailing Address - Fax:
Practice Address - Street 1:210 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1071
Practice Address - Country:US
Practice Address - Phone:248-635-5848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11452255A2300X
IL096.0056592255A2300X
MI26010026862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer