Provider Demographics
NPI:1558332122
Name:SMITH, BERYL ANN (PT)
Entity Type:Individual
Prefix:
First Name:BERYL
Middle Name:ANN
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 1:2031 VIENNA PKWY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1356
Mailing Address - Country:US
Mailing Address - Phone:937-439-1868
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS PLAZA
Practice Address - Street 2:ORTHOPAEDIC CENTER FOR SPINAL & PEDIATRIC CARE
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1815
Practice Address - Country:US
Practice Address - Phone:937-641-3010
Practice Address - Fax:937-641-5003
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-10782225100000X, 2251P0200X, 2251X0800X
TN2896324225100000X, 2251P0200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2487492Medicaid
OH2487492OtherBCMH
OH00000330619OtherANTHEM BCBS
OH00000330619OtherANTHEM BCBS
OH2487492Medicaid