Forrest Smith

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT5768 Issued in MS

Practice address

15476B Dedeaux Rd
Gulfport, MS 39503-2637

Phone

(228) 539-3232

Fax

(228) 539-3230

NPI assigned

Sep 16, 2015

Last updated

Sep 16, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1442361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442361600000",
    "number": "1619346095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8419",
            "city": "BILOXI",
            "state": "MS",
            "postal_code": "395358087",
            "telephone_number": "228-388-5714",
            "fax_number": "228-388-0017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15476B DEDEAUX RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395032637",
            "telephone_number": "228-539-3232",
            "fax_number": "228-539-3230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "FORREST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-16",
        "last_updated": "2015-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT5768",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1003819608",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529917620",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Claudia Bridgett Smith, RN
• Crystal Ann Smith
• Daniel Bruce Smith, M.D., PHD
• Elena C Smith
• Emily A Smith, P-LPC
• Heather Michele Smith, PHD
• Jasmine L. Smith, LPC
• John D Smith III, CRNP
• Joshua De'Von Smith, MA, DPC, LPC
• Joyce Smith, PCCSS

• Physical Therapist in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Physical Therapist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2015; 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.