Provider Demographics
NPI:1144477977
Name:SMART, MARY MEGAN (ATC, CI)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MEGAN
Last Name:SMART
Suffix:
Gender:F
Credentials:ATC, CI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S UNIVERSITY PARKS DR
Mailing Address - Street 2:APT. 1804
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-1006
Mailing Address - Country:US
Mailing Address - Phone:318-235-3651
Mailing Address - Fax:
Practice Address - Street 1:150 BEAR RUN
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-1267
Practice Address - Country:US
Practice Address - Phone:318-235-3651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer