Provider Demographics
NPI:1235538786
Name:SMITH, CAROLINE ANN (PT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4825 S OLD PEACHTREE RD
Mailing Address - Street 2:STE 1100
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-1504
Mailing Address - Country:US
Mailing Address - Phone:770-449-5152
Mailing Address - Fax:866-821-7683
Practice Address - Street 1:4825 S OLD PEACHTREE RD
Practice Address - Street 2:STE 1100
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30071-1504
Practice Address - Country:US
Practice Address - Phone:770-449-5152
Practice Address - Fax:866-821-7683
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist