Provider Demographics
NPI:1215952593
Name:SMITH, EDWARD B (MS PT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS PT
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Mailing Address - Street 1:5709 SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-1239
Mailing Address - Country:US
Mailing Address - Phone:269-556-0930
Mailing Address - Fax:269-429-0114
Practice Address - Street 1:5709 SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-1239
Practice Address - Country:US
Practice Address - Phone:269-556-0930
Practice Address - Fax:269-429-0114
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-12-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5501012887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00333051OtherRAILROAD MEDICARE
MIP00333051OtherRAILROAD MEDICARE