Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081S0010X | Sports Medicine | AT1201 | TX |
N | 213ES0000X | Sports Medicine | AT1201 | TX |
Y | 225200000X | Physical Therapy Assistant | 2123567 | TX |
NPI | 1225677768 |
---|---|
Provider Name | Mr. Matthew James Smith |
First Address | Richmond, TX 77407-2874 |
Second Address | Katy, TX 77494-5718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2020 |
Last Update Date | 01/01/2020 |