Provider Demographics
NPI:1699809012
Name:SMITH, DINA M (PT)
Entity Type:Individual
Prefix:MS
First Name:DINA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2993 CHICA CIR
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-6805
Mailing Address - Country:US
Mailing Address - Phone:321-759-8380
Mailing Address - Fax:321-733-0928
Practice Address - Street 1:2993 CHICA CIR
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-6805
Practice Address - Country:US
Practice Address - Phone:321-759-8380
Practice Address - Fax:321-733-0928
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 135832251P0200X, 2251X0800X
FLPT13583222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5470501OtherFIRST HEALTH
FLY9767OtherBLUE CROSS AND BLUE SHIEL
FL811612100Medicaid
FL2110946OtherFIRST HEALTH
FL886247800Medicaid
FL886247800Medicaid