Provider Demographics
NPI:1699008771
Name:SMITKO, KURTIS A
Entity Type:Individual
Prefix:
First Name:KURTIS
Middle Name:A
Last Name:SMITKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3090 BANNOCKBURN DR SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9369
Mailing Address - Country:US
Mailing Address - Phone:616-826-5862
Mailing Address - Fax:
Practice Address - Street 1:3090 BANNOCKBURN DR SE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9369
Practice Address - Country:US
Practice Address - Phone:616-826-5862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist