Provider Demographics
NPI:1255541637
Name:SMITH, XENOPHON PHILLIP (PT)
Entity type:Individual
Prefix:
First Name:XENOPHON
Middle Name:PHILLIP
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:KS
Mailing Address - Zip Code:66861-1526
Mailing Address - Country:US
Mailing Address - Phone:620-382-2205
Mailing Address - Fax:
Practice Address - Street 1:302 ELM ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KS
Practice Address - Zip Code:66861
Practice Address - Country:US
Practice Address - Phone:620-382-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01959225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11-01959OtherPT LICENSE NUMBER