Active NPI
Matthew Edwin Smith, DPT
- Physical Therapist
- Draper, UT
National Provider Identifier
1851495030
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT-1901
- Practice address
- 65 E Wadsworth Park Dr Ste 230
Draper, UT 84020-8096 - Phone
- (208) 899-3724
- NPI assigned
- Sep 11, 2006
- 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 13
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 25955 | MA | |
| Physical Therapist | 225100000X | 61680 | OR | |
| Physical Therapist | 225100000X | 1694 | ND | |
| Physical Therapist | 225100000X | PTP-PT-LIC-13927 | MT | |
| Physical Therapist | 225100000X | PT6071 | ME | |
| Physical Therapist | 225100000X | 11-06915 | KS | |
| Physical Therapist | 225100000X | 10529 | MN | |
| Physical Therapist | 225100000X | PTH10586 | AL | |
| Physical Therapist | 225100000X | 4722 | NV | |
| Physical Therapist | 225100000X | PT6056 | NM | |
| Physical Therapist | 225100000X | 5501301784 | MI | |
| Physical Therapist | 225100000X | 301958 | CA | |
| Physical Therapist | 225100000X | PT-1901 | ID | Primary |
Addresses
Primary practice location
65 E Wadsworth Park Dr Ste 230
Draper, UT 84020-8096
Mailing address
65 E Wadsworth Park Dr Ste 230
Draper, UT 84020-8096
Phone (208) 899-3724
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4722 | NV | MD | General Practice Dentistry |
| PTH10586 | AL | MD | Physical Therapist |
| 301958 | CA | MD | Physical Therapist |
| 11-06915 | KS | MD | Physical Therapist |
| 25955 | MA | MD | Physical Therapist |
| PT6071 | ME | MD | Physical Therapist |
| 5501301784 | MI | MD | Physical Therapist |
| 10529 | MN | MD | Physical Therapist |
| PTP-PT-LIC-13927 | MT | MD | Physical Therapist |
| PT6056 | NM | MD | Physical Therapist |
| 61680 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654646400000",
"number": "1851495030",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "65 E WADSWORTH PARK DR STE 230",
"city": "DRAPER",
"state": "UT",
"postal_code": "840208096",
"telephone_number": "208-899-3724"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65 E WADSWORTH PARK DR STE 230",
"city": "DRAPER",
"state": "UT",
"postal_code": "840208096",
"telephone_number": "208-899-3724"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "MATTHEW",
"middle_name": "EDWIN",
"name_prefix": "Mr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-11",
"last_updated": "2022-06-08",
"certification_date": "2022-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "25955",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "61680",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ND",
"license": "1694",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MT",
"license": "PTP-PT-LIC-13927",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ME",
"license": "PT6071",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KS",
"license": "11-06915",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "10529",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AL",
"license": "PTH10586",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NV",
"license": "4722",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "PT6056",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501301784",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "301958",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT-1901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Draper, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.