Provider Demographics
NPI:1174612527
Name:DE SMIDT, PIETER (PT)
Entity type:Individual
Prefix:
First Name:PIETER
Middle Name:
Last Name:DE SMIDT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 CENTRAL PARKWAY NORTH
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5024
Mailing Address - Country:US
Mailing Address - Phone:210-541-4500
Mailing Address - Fax:210-541-4508
Practice Address - Street 1:2235 THOUSAND OAKS DR
Practice Address - Street 2:SUITE 118
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3969
Practice Address - Country:US
Practice Address - Phone:210-402-3856
Practice Address - Fax:210-490-5921
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1072643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB117967Medicare PIN
TX1072643OtherTX LICENSE