Provider Demographics
NPI:1700242484
Name:SMITH, STEPHEN V (PT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:V
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4091 STATE HIGHWAY 6 S STE B
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-9476
Mailing Address - Country:US
Mailing Address - Phone:979-690-2478
Mailing Address - Fax:979-690-2402
Practice Address - Street 1:4091 STATE HIGHWAY 6 S STE B
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-9476
Practice Address - Country:US
Practice Address - Phone:979-690-2478
Practice Address - Fax:979-690-2402
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1263219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist