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Individual
MR. JUSTIN RYAN SMALLWOOD
Active
Individual
MR. JUSTIN RYAN SMALLWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1113686
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
138047103
FIRSTCARE
TX
05
—
220047901
—
TX
05
—
220047902
—
TX
01
—
8T2619
BLUE CROSS BLUE SHIELD
TX
01
—
P00304755
MEDICARE RAILROAD
TX
Enumeration date
06/13/2005
Last updated
08/28/2020
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