Provider Demographics
NPI:1780639856
Name:SMITH, BRIAN RICHARD (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:RICHARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-756-3107
Mailing Address - Fax:919-535-3271
Practice Address - Street 1:8410 LOUISBURG RD STE 130
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616
Practice Address - Country:US
Practice Address - Phone:919-514-3177
Practice Address - Fax:919-939-2353
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP16466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI413289OtherBLUE CHIP
RI31305-4OtherBLUE CROSS
RIPT02015OtherSTATE LICENSE NUMBER