Provider Demographics
NPI:1861460529
Name:SMITH, KEVIN PAUL (PT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:PAUL
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5664 RED BEND LN
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6300
Mailing Address - Country:US
Mailing Address - Phone:614-560-1246
Mailing Address - Fax:614-775-9368
Practice Address - Street 1:1090 BEECHER XING N
Practice Address - Street 2:SUITE B
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4566
Practice Address - Country:US
Practice Address - Phone:614-775-9273
Practice Address - Fax:614-775-9368
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH68662251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic