Individual
DEREK MILES SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
4780 N JOSEY LN, CARROLLTON, TX 75010-4615
(972) 492-1334
(972) 492-5174
Mailing address
4780 N JOSEY LN, CARROLLTON, TX 75010-4615
(972) 492-1334
(972) 492-5174
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1140028
TX
2251X0800X
Orthopedic Physical Therapist
1140028
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
854T69
BC/BS TX - EFFECT 02/01/2011
TX
01
—
8D5829
MEDICARE PART B - PRIOR TO 2/1/11
TX
01
—
8T3800
BCBS
TX
01
—
P00954365
RAILROAD MEDICARE
TX
01
—
TXB121221
MEDICARE PART B - EFFECT 3/3/11
TX
Enumeration date
10/12/2006
Last updated
05/22/2013
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