Provider Demographics
NPI:1295708337
Name:SMITH, CASEY RYAN (ATC)
Entity type:Individual
Prefix:MR
First Name:CASEY
Middle Name:RYAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 VICTORY AVE
Mailing Address - Street 2:DALLAS MAVERICKS
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219
Mailing Address - Country:US
Mailing Address - Phone:214-665-4648
Mailing Address - Fax:214-665-4647
Practice Address - Street 1:2500 VICTORY AVE
Practice Address - Street 2:DALLAS MAVERICKS
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219
Practice Address - Country:US
Practice Address - Phone:214-665-4648
Practice Address - Fax:214-665-4647
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT3197225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist