Provider Demographics
NPI:1194040238
Name:SMITH, CARRIE ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:ANN
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 1:5725 N COUNTY ROAD 775 W
Mailing Address - Street 2:
Mailing Address - City:WEST BADEN SPRINGS
Mailing Address - State:IN
Mailing Address - Zip Code:47469-9308
Mailing Address - Country:US
Mailing Address - Phone:812-936-7258
Mailing Address - Fax:
Practice Address - Street 1:5725 N COUNTY ROAD 775 W
Practice Address - Street 2:
Practice Address - City:WEST BADEN SPRINGS
Practice Address - State:IN
Practice Address - Zip Code:47469-9308
Practice Address - Country:US
Practice Address - Phone:812-936-7258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009255A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist