Provider Demographics
NPI:1356366553
Name:SMITH, DARYL JAMES (MPT)
Entity type:Individual
Prefix:MR
First Name:DARYL
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1744 E COMMON ST STE 400
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6079
Mailing Address - Country:US
Mailing Address - Phone:830-620-4922
Mailing Address - Fax:830-625-1194
Practice Address - Street 1:1744 E COMMON ST STE 400
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6079
Practice Address - Country:US
Practice Address - Phone:830-620-4922
Practice Address - Fax:830-625-1194
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13483652251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8324451Medicaid
TX1348365OtherLICENSE