Provider Demographics
NPI:1811452832
Name:SMITH, ZACHARY (PT, DPT)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 DRIFTWOOD HILLS WAY
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-2184
Mailing Address - Country:US
Mailing Address - Phone:254-226-0588
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:104 DRIFTWOOD HILLS WAY
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-2184
Practice Address - Country:US
Practice Address - Phone:254-226-0588
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1315529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist