Provider Demographics
NPI:1568666477
Name:SMITH, KIMBERLY ANGELA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANGELA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 RUTGERS PL
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4906
Mailing Address - Country:US
Mailing Address - Phone:914-713-4904
Mailing Address - Fax:
Practice Address - Street 1:24 RUTGERS PL
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4906
Practice Address - Country:US
Practice Address - Phone:914-713-4904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist