Provider Demographics
NPI:1720091382
Name:SMITH CENTER FOR REHABILITATION, LLC
Entity Type:Organization
Organization Name:SMITH CENTER FOR REHABILITATION, LLC
Other - Org Name:JOINT EFFORT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT MS COMT
Authorized Official - Phone:602-870-1821
Mailing Address - Street 1:9225 N. 3RD ST.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020
Mailing Address - Country:US
Mailing Address - Phone:602-870-1821
Mailing Address - Fax:602-870-1824
Practice Address - Street 1:9225 N. 3RD ST.
Practice Address - Street 2:SUITE 300
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020
Practice Address - Country:US
Practice Address - Phone:602-870-1821
Practice Address - Fax:602-870-1824
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMITH CENTER FOR REHABILITATION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225100000X
AZ3899261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZA0297910OtherAZ PROVIDER
AZ497009Medicaid
AZ78784Medicare PIN
78784Medicare PIN
AZS94264Medicare UPIN
AZZ74784Medicare UPIN