Derek Lee Smith, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2018037417 Issued in MO

Practice address

204 Seminary St
Warsaw, MO 65355

Phone

(660) 438-6993

NPI assigned

Feb 21, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550707200000",
    "number": "1487111969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33700 HILTY AVE",
            "city": "WARSAW",
            "state": "MO",
            "postal_code": "653555245",
            "telephone_number": "417-855-9540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 SEMINARY ST",
            "city": "WARSAW",
            "state": "MO",
            "postal_code": "65355",
            "telephone_number": "660-438-6993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "DEREK",
        "middle_name": "LEE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-02-21",
        "last_updated": "2019-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2018037417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Rowland, NP
• Samuel and Jill Hieronymus
• Sedalia Eye Associates, P. C.
• Keith Edward Segall, DO
• Show Me Physical Therapy LLC
• Drew A Smith, M.D.
• Lauren Sons, LMSW
• Michael Sperry, PHARMD
• Peter Howard Steadman, DMD
• Rebecca L Steenburgen, LPC

• Physical Therapy Assistant in Warsaw, MO
• Providers in Warsaw, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.