Individual
DEREK MILES SMITH
Active
Individual
DEREK MILES SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
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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