Provider Demographics
NPI:1396705760
Name:SMITH, MICHAEL EARL (PT ATC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EARL
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:347 MAIN ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1338
Mailing Address - Country:US
Mailing Address - Phone:207-839-9090
Mailing Address - Fax:207-839-9091
Practice Address - Street 1:347 MAIN ST UNIT 1
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1338
Practice Address - Country:US
Practice Address - Phone:207-839-9090
Practice Address - Fax:207-839-9091
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT2672255A2300X
MEPT1931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer