Provider Demographics
NPI:1265984496
Name:NESMITH, MACY (PT, DPT)
Entity type:Individual
Prefix:
First Name:MACY
Middle Name:
Last Name:NESMITH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N ROARING SPRINGS RD
Mailing Address - Street 2:APT 1209
Mailing Address - City:WESTWORTH VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76114-3506
Mailing Address - Country:US
Mailing Address - Phone:214-957-9727
Mailing Address - Fax:
Practice Address - Street 1:250 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6585
Practice Address - Country:US
Practice Address - Phone:817-550-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1274432225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist