Provider Demographics
NPI:1558634865
Name:SMITH, VALERIE S (LMT)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 JOHNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-2725
Mailing Address - Country:US
Mailing Address - Phone:724-954-2833
Mailing Address - Fax:
Practice Address - Street 1:159 BUTLER RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-2328
Practice Address - Country:US
Practice Address - Phone:724-548-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG004797225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist