Provider Demographics
NPI:1093190555
Name:SMITH, ERIN KIMBERLY I (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:KIMBERLY
Last Name:SMITH
Suffix:I
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:ERIN
Other - Middle Name:KIMBERLY
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:407 D ST
Mailing Address - Street 2:APARTMENT 305
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02210-1941
Mailing Address - Country:US
Mailing Address - Phone:518-590-3944
Mailing Address - Fax:
Practice Address - Street 1:11831 US-9W
Practice Address - Street 2:
Practice Address - City:WEST COXSACKIE
Practice Address - State:NY
Practice Address - Zip Code:12192
Practice Address - Country:US
Practice Address - Phone:518-731-1157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217482251S0007X
NY0388652251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports