Provider Demographics
NPI:1528209913
Name:SMITH, KAREN WHEAT (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:WHEAT
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 BRIAR BROOK RUN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-9670
Mailing Address - Country:US
Mailing Address - Phone:315-391-8034
Mailing Address - Fax:
Practice Address - Street 1:501 BRIAR BROOK RUN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-8751
Practice Address - Country:US
Practice Address - Phone:315-391-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-13
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010547-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist