Provider Demographics
NPI:1639361256
Name:SMITH, SHERISE R (MS,PT)
Entity Type:Individual
Prefix:
First Name:SHERISE
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E CAPOVILLA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4340
Mailing Address - Country:US
Mailing Address - Phone:866-466-1912
Mailing Address - Fax:
Practice Address - Street 1:505 E CAPOVILLA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4340
Practice Address - Country:US
Practice Address - Phone:866-466-1912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV485225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist