Provider Demographics
NPI:1376829168
Name:SMITH, KATHLEEN JEANNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JEANNE
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 1:6534 ANTHONY DR STE C
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1421
Mailing Address - Country:US
Mailing Address - Phone:585-869-5140
Mailing Address - Fax:585-869-5142
Practice Address - Street 1:6534 ANTHONY DR STE C
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1421
Practice Address - Country:US
Practice Address - Phone:585-869-5140
Practice Address - Fax:585-869-5142
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0341191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist