Provider Demographics
NPI:1295886349
Name:SMITH, CAMILLE (MPT)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15135 MEMORIAL DR
Mailing Address - Street 2:# 6206
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-4323
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 TOWN AND COUNTRY LN
Practice Address - Street 2:SUITE 230
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2226
Practice Address - Country:US
Practice Address - Phone:713-461-5050
Practice Address - Fax:713-461-5676
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21440225100000X
TX1187030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00636YMedicare PIN
TX8L13425Medicare PIN