Active NPI
Ian M Smith, PTA
- Physical Therapy Assistant
- Caro, MI
National Provider Identifier
1164901120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5502005601
- Practice address
- 1525 W Caro Rd
Caro, MI 48723-9686 - Phone
- (989) 672-0866
- NPI assigned
- Aug 10, 2018
- Last updated
- Aug 10, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 5502005601 | MI | Primary |
Addresses
Primary practice location
1525 W Caro Rd
Caro, MI 48723-9686
Mailing address
4433 Altadena Dr
Bay City, MI 48706-2513
Phone (989) 992-9660
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5502005601 | MI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533859200000",
"number": "1164901120",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4433 ALTADENA DR",
"city": "BAY CITY",
"state": "MI",
"postal_code": "487062513",
"telephone_number": "989-992-9660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1525 W CARO RD",
"city": "CARO",
"state": "MI",
"postal_code": "487239686",
"telephone_number": "989-672-0866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "IAN",
"middle_name": "M",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-10",
"last_updated": "2018-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MI",
"license": "5502005601",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Caro, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.