Provider Demographics
NPI:1295322063
Name:SMITH, RHAE'VEN DARBY ELLIS (DPT)
Entity type:Individual
Prefix:MS
First Name:RHAE'VEN
Middle Name:DARBY ELLIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RHAE'VEN
Other - Middle Name:DARBY
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 SEMOIA LN
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-9796
Mailing Address - Country:US
Mailing Address - Phone:601-540-8493
Mailing Address - Fax:
Practice Address - Street 1:1645 W GOVERNMENT ST STE D
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-4602
Practice Address - Country:US
Practice Address - Phone:769-233-5003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT6955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist