Provider Demographics
NPI:1700984051
Name:SMITH, ERIC MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:MICHAEL
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 1:13011 SUMMERFIELD SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-7402
Mailing Address - Country:US
Mailing Address - Phone:813-374-2209
Mailing Address - Fax:813-374-2211
Practice Address - Street 1:412 12TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-1120
Practice Address - Country:US
Practice Address - Phone:727-898-5001
Practice Address - Fax:727-894-0554
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22333225100000X
FLPT 22333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU7167ZMedicare ID - Type Unspecified
FLK8249Medicare ID - Type UnspecifiedGROUP ID