1174703177 NPI number — SMITH PHYSICAL THERAPY AND SPORTS MEDICINE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174703177 NPI number — SMITH PHYSICAL THERAPY AND SPORTS MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SMITH PHYSICAL THERAPY AND SPORTS MEDICINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174703177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7516 COUNTRY PRIDE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IMLAY CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48444-9530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-390-1825
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6444 MORRIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLETTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48453-1398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
810-256-0016
Provider Business Practice Location Address Fax Number:
888-980-9651
Provider Enumeration Date:
11/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
989-390-1825

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501012409 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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