Provider Demographics
NPI:1164531893
Name:KANCHAN, SMITA
Entity Type:Individual
Prefix:
First Name:SMITA
Middle Name:
Last Name:KANCHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 RESERVE CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7180
Mailing Address - Country:US
Mailing Address - Phone:407-275-7169
Mailing Address - Fax:
Practice Address - Street 1:453 N KIRKMAN RD STE 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-1109
Practice Address - Country:US
Practice Address - Phone:407-521-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT7859OtherLICENSE#