Provider Demographics
NPI:1639845282
Name:NEW SMYRNA BEACH PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:NEW SMYRNA BEACH PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:703-489-7597
Mailing Address - Street 1:701 E 3RD AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-3104
Mailing Address - Country:US
Mailing Address - Phone:386-957-3902
Mailing Address - Fax:386-232-9761
Practice Address - Street 1:701 E 3RD AVE UNIT 6
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32169-3104
Practice Address - Country:US
Practice Address - Phone:386-957-3902
Practice Address - Fax:386-232-9761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-23
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty