Provider Demographics
NPI:1942200621
Name:SMITH & PROTHERO PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SMITH & PROTHERO PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-939-2262
Mailing Address - Street 1:807A S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3610
Mailing Address - Country:US
Mailing Address - Phone:410-939-2262
Mailing Address - Fax:410-939-7119
Practice Address - Street 1:807A S UNION AVE
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3610
Practice Address - Country:US
Practice Address - Phone:410-939-2262
Practice Address - Fax:410-939-7119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCB2775OtherRAILROAD MEDICARE
MDLS73SMOtherCAREFIRST BC/BS
MD5874017-00Medicaid
MD954LMedicare ID - Type Unspecified