Provider Demographics
NPI:1376938621
Name:SMILEY, KRISTIN MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MICHELLE
Last Name:SMILEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:MICHELLE
Other - Last Name:STOLTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 FOWLER AVE.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603
Mailing Address - Country:US
Mailing Address - Phone:570-759-2000
Mailing Address - Fax:570-585-1321
Practice Address - Street 1:3750 ROUTE 220 HIGHWAY
Practice Address - Street 2:
Practice Address - City:HUGHESVILLE
Practice Address - State:PA
Practice Address - Zip Code:17737
Practice Address - Country:US
Practice Address - Phone:570-759-2000
Practice Address - Fax:570-585-1321
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008312L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist