Provider Demographics
NPI:1558600403
Name:SMITH, CYNTHIA ASHLEY (DPT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ASHLEY
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WHALERS CV
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2925
Mailing Address - Country:US
Mailing Address - Phone:631-235-4257
Mailing Address - Fax:
Practice Address - Street 1:27 WHALERS CV
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2925
Practice Address - Country:US
Practice Address - Phone:631-235-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12285-24225100000X
CT9615225100000X
NY036929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist