Provider Demographics
NPI:1124283783
Name:SMITH, MICHAEL LOREN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LOREN
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2808 MCLAMB PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1600
Mailing Address - Country:US
Mailing Address - Phone:919-736-2157
Mailing Address - Fax:919-580-0424
Practice Address - Street 1:2808 MCLAMB PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1600
Practice Address - Country:US
Practice Address - Phone:919-736-2157
Practice Address - Fax:919-580-0424
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH41523Medicare UPIN