Provider Demographics
NPI:1942313457
Name:SMITH, KELLI PATRICE (PT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:PATRICE
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 1:150 E. SONTERRA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258
Mailing Address - Country:US
Mailing Address - Phone:210-489-7270
Mailing Address - Fax:210-403-2445
Practice Address - Street 1:150 E. SONTERRA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-489-7270
Practice Address - Fax:210-403-2445
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31019202251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
7419883OtherAETNA
8T6673OtherBCBS OF TEXAS
7419883OtherAETNA