Provider Demographics
NPI:1922033356
Name:SMURDA, MARCUS KYLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:KYLE
Last Name:SMURDA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:625 N MUHLENBERG ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4949
Mailing Address - Country:US
Mailing Address - Phone:610-351-9200
Mailing Address - Fax:
Practice Address - Street 1:6299 ROUTE 309
Practice Address - Street 2:SUITE 305
Practice Address - City:NEW TRIPOLI
Practice Address - State:PA
Practice Address - Zip Code:18066-2048
Practice Address - Country:US
Practice Address - Phone:610-767-8480
Practice Address - Fax:610-767-8487
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA092626TQ8Medicare ID - Type Unspecified