Provider Demographics
NPI:1447619341
Name:SMITH, CARRIE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 MORRIS RD
Mailing Address - Street 2:APT A24
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3069
Mailing Address - Country:US
Mailing Address - Phone:443-223-9719
Mailing Address - Fax:
Practice Address - Street 1:450 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1337
Practice Address - Country:US
Practice Address - Phone:484-368-1460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART006075172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker