Provider Demographics
NPI:1225369150
Name:SMYTH, KIRSTIN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:
Last Name:SMYTH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:KIRSTIN
Other - Middle Name:
Other - Last Name:CATALANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4175 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7639
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:2814 GRAY FOX RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-8422
Practice Address - Country:US
Practice Address - Phone:704-821-0568
Practice Address - Fax:704-821-0570
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01325000225100000X
NCP18096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist