Provider Demographics
NPI:1376063057
Name:SMITH, KATIE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 PARKCREST DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1162
Mailing Address - Country:US
Mailing Address - Phone:815-579-6914
Mailing Address - Fax:
Practice Address - Street 1:1552 COUNTRY CLUB PLAZA DR UNIT 15700
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3859
Practice Address - Country:US
Practice Address - Phone:636-724-1127
Practice Address - Fax:815-314-5112
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist