Provider Demographics
NPI:1962420216
Name:SMITH, ERIC W (MPT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 COAST VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2711
Mailing Address - Country:US
Mailing Address - Phone:805-565-5670
Mailing Address - Fax:805-565-5690
Practice Address - Street 1:1122 COAST VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-2711
Practice Address - Country:US
Practice Address - Phone:805-565-5670
Practice Address - Fax:805-565-5690
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26913261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT26913OtherSTATE LICENSE
CAWPT26913BMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID
CAQ11766Medicare UPIN