Provider Demographics
NPI:1881675874
Name:SMITH, GARY T (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS, PT
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Mailing Address - Street 1:2919 S ELLSWORTH RD
Mailing Address - Street 2:STE 135
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85212-2168
Mailing Address - Country:US
Mailing Address - Phone:480-967-6888
Mailing Address - Fax:480-967-6887
Practice Address - Street 1:3602 E GREENWAY RD
Practice Address - Street 2:STE 106
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4648
Practice Address - Country:US
Practice Address - Phone:602-643-0300
Practice Address - Fax:602-643-0038
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2021-02-02
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Provider Licenses
StateLicense IDTaxonomies
AZ3899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ497009Medicaid
AZ74785Medicare PIN
AZS94264Medicare UPIN