Provider Demographics
NPI:1962552166
Name:GARRY V D SMITH PC
Entity type:Organization
Organization Name:GARRY V D SMITH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:VAN DORN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:830-597-4258
Mailing Address - Street 1:BOX 173
Mailing Address - Street 2:406 E 8TH ST
Mailing Address - City:CAMP WOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78833
Mailing Address - Country:US
Mailing Address - Phone:830-597-4258
Mailing Address - Fax:
Practice Address - Street 1:801 BEDELL
Practice Address - Street 2:VAL VERDE REGIONAL MEDICAL CENTER REHAB DEPT
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78846
Practice Address - Country:US
Practice Address - Phone:830-703-1229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1004943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty