Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1158873 | TX |
NPI | 1427348234 |
---|---|
Provider Name | Mr. Bert Doulgas Smith |
First Address | Irving, TX 75061-2220 |
Second Address | Irving, TX 75061-2220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2011 |
Last Update Date | 13/04/2011 |