Provider Demographics
NPI:1083878441
Name:SMITH, MARY E (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:4651 NIXON PARK DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-9759
Mailing Address - Country:US
Mailing Address - Phone:315-492-0592
Mailing Address - Fax:315-492-1203
Practice Address - Street 1:8390 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1002
Practice Address - Country:US
Practice Address - Phone:315-635-5000
Practice Address - Fax:315-622-1110
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY024348225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist