Provider Demographics
NPI:1265902498
Name:SMITH, TROY W (PT)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:W
Last Name:SMITH
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 1:6314 WHISKEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-8762
Mailing Address - Country:US
Mailing Address - Phone:239-432-0556
Mailing Address - Fax:239-432-9727
Practice Address - Street 1:6314 WHISKEY CREEK DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8762
Practice Address - Country:US
Practice Address - Phone:239-432-0556
Practice Address - Fax:239-432-9727
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14224208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty