Provider Demographics
NPI:1992840516
Name:SMITH, CHRISTOPHER PETER (DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PETER
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 JIMMY ANN DR
Mailing Address - Street 2:APT. 1514
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-7408
Mailing Address - Country:US
Mailing Address - Phone:504-343-5827
Mailing Address - Fax:
Practice Address - Street 1:365 BILL FRANCE BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1301
Practice Address - Country:US
Practice Address - Phone:386-323-5840
Practice Address - Fax:386-323-0696
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist