Provider Demographics
NPI:1891033890
Name:SMITH, KAMALA J (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:KAMALA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:KAMI
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2109 WAVERLY WOODS DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6868
Mailing Address - Country:US
Mailing Address - Phone:843-260-7424
Mailing Address - Fax:
Practice Address - Street 1:500 S DARGAN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2548
Practice Address - Country:US
Practice Address - Phone:843-678-4196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11922251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics