Provider Demographics
NPI:1841233665
Name:KASTURY, SMITA R (BS)
Entity Type:Individual
Prefix:
First Name:SMITA
Middle Name:R
Last Name:KASTURY
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31370 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48082-2450
Mailing Address - Country:US
Mailing Address - Phone:586-285-0545
Mailing Address - Fax:586-279-1700
Practice Address - Street 1:31370 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48082-2450
Practice Address - Country:US
Practice Address - Phone:586-285-0545
Practice Address - Fax:586-279-1700
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN94050004Medicare ID - Type UnspecifiedPHYSICAL THERAPIST