Provider Demographics
NPI:1861720120
Name:SMYTHE, PHILIP J (PT)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:SMYTHE
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 1:21710 PEEPSOCK CIR
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:49931-1050
Mailing Address - Country:US
Mailing Address - Phone:906-482-6994
Mailing Address - Fax:906-482-6994
Practice Address - Street 1:21710 PEEPSOCK CIR
Practice Address - Street 2:
Practice Address - City:HOUGHTON
Practice Address - State:MI
Practice Address - Zip Code:49931-1050
Practice Address - Country:US
Practice Address - Phone:906-482-6994
Practice Address - Fax:906-482-6994
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1579455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist