Provider Demographics
NPI:1255611372
Name:SMITH, MARCIA JEAN (PT)
Entity type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:J
Other - Last Name:COOLEY SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2820 MCKINNON ST
Mailing Address - Street 2:5009
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1102
Mailing Address - Country:US
Mailing Address - Phone:248-318-9053
Mailing Address - Fax:
Practice Address - Street 1:550 E ANN ARBOR AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-6718
Practice Address - Country:US
Practice Address - Phone:214-376-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-20
Last Update Date:2011-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1183259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist