Provider Demographics
NPI:1154073641
Name:SMITH, EMILY K (PT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ELLIOTT CIR
Mailing Address - Street 2:
Mailing Address - City:GLENBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04401-1141
Mailing Address - Country:US
Mailing Address - Phone:207-944-0518
Mailing Address - Fax:
Practice Address - Street 1:16 ELLIOTT CIR
Practice Address - Street 2:
Practice Address - City:GLENBURN
Practice Address - State:ME
Practice Address - Zip Code:04401-1141
Practice Address - Country:US
Practice Address - Phone:207-944-0518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist