| Doctor Name: | NICHOLAS MICHAEL SMITH |
| NPI Number: | 1093056103 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPT, ATC |
| License Number: | 035839 |
| Business Practice Address: | 6000 Brockton Dr Ste 107 Lockport, NY - 140949273 |
| Business Phone Number: | 7162011049 |
| Business Fax Number: | 7162011156 |
| Mailing Address: | 6000 Brockton Dr Ste 107, LOCKPORT |
| State: | NY |
| Postal Code: | 140949273 |
| Phone Number: | 7162011049 |
| Fax Number: | 7162011156 |
| NPI Enumeration Date: | 03/14/2013 |
| NPI Last Update Date: | 09/30/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 035839 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |