Provider Demographics
NPI:1316924202
Name:SMITH, ALAN R (PT)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1322 N WINDMILL RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-2841
Mailing Address - Country:US
Mailing Address - Phone:316-788-4962
Mailing Address - Fax:
Practice Address - Street 1:728 N EMPORIA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3708
Practice Address - Country:US
Practice Address - Phone:316-263-1952
Practice Address - Fax:316-263-4384
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01524225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist