Provider Demographics
NPI:1992744429
Name:SMITH, SHAUNA FORSYTH (PT)
Entity type:Individual
Prefix:MS
First Name:SHAUNA
Middle Name:FORSYTH
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SHAUNA
Other - Middle Name:LEE
Other - Last Name:FORSYTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6451 N COLUMBUS BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-2504
Mailing Address - Country:US
Mailing Address - Phone:520-977-3383
Mailing Address - Fax:
Practice Address - Street 1:2560 E FORT LOWELL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1514
Practice Address - Country:US
Practice Address - Phone:520-323-9086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992744429OtherNPI
AZ109802Medicare PIN