Provider Demographics
NPI:1033208988
Name:SMITH, FELICE (BSPT)
Entity Type:Individual
Prefix:MRS
First Name:FELICE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2496 DODGESON RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:NY
Mailing Address - Zip Code:14005-9785
Mailing Address - Country:US
Mailing Address - Phone:585-547-3522
Mailing Address - Fax:
Practice Address - Street 1:422 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1023
Practice Address - Country:US
Practice Address - Phone:585-786-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012727-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist