Provider Demographics
NPI:1801197173
Name:SMITH, WILLIAM J (MSPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9152
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-0152
Mailing Address - Country:US
Mailing Address - Phone:518-320-8706
Mailing Address - Fax:518-389-1788
Practice Address - Street 1:1659 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COLONIE
Practice Address - State:NY
Practice Address - Zip Code:12205-4039
Practice Address - Country:US
Practice Address - Phone:518-320-8706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02251063Medicaid
NY02251063Medicaid