Smith, Mark David
Smith, Mark David is an individual health care provider with primary practice located at 1507 W Knapp St , Rice Lake WI 54866. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Smith, Mark David can be contacted via phone (877) 823-0508.Contact Information
Primary practice address
1507 W Knapp St
Rice Lake WI 54866
Phone: (877) 823-0508
Fax: (715) 236-3615
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | 6121024 | Wisconsin |
Profile Details
| NPI number | 1316995525 |
|---|---|
| LBN Legal business name | Smith, Mark David |
| Credentials | Physical Therapist (PT) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 4th, 2006 |
| Last updated | Sep 25th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316995525 | NPPES |
| Wisconsin | MEDICAID | 40312100 |
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