Individual
MR. DAVID SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, CMDT
Contact information
Practice address
5000 N WICKHAM RD STE 107, MELBOURNE, FL 32940-7321
(321) 701-4020
(321) 701-4009
Mailing address
5000 N WICKHAM RD STE 107, MELBOURNE, FL 32940-7321
(321) 701-4020
(321) 701-4009
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT20472
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020385000
—
FL
01
—
K9101
HARBOR CITY PHYSICAL THERAPY GROUP NUMBER
FL
01
—
PT-20472
STATE OF FL. PT LICENSE
FL
Enumeration date
06/13/2006
Last updated
06/16/2018
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