Provider Demographics
NPI:1649869785
Name:SMILEY, KARL THOMAS (DPT)
Entity type:Individual
Prefix:MR
First Name:KARL
Middle Name:THOMAS
Last Name:SMILEY
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 1:3065 SOUTHWESTERN BLVD
Mailing Address - Street 2:#108
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127
Mailing Address - Country:US
Mailing Address - Phone:716-608-6730
Mailing Address - Fax:716-608-6445
Practice Address - Street 1:3065 SOUTHWESTERN BLVD
Practice Address - Street 2:#108
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-608-6730
Practice Address - Fax:716-608-6445
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046373225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05036773Medicaid