Provider Demographics
NPI:1750413183
Name:SMITH, MICHELE LINETTE (LPT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LINETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PIN OAK LN
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778-2775
Mailing Address - Country:US
Mailing Address - Phone:828-686-4452
Mailing Address - Fax:828-686-4452
Practice Address - Street 1:130 EAGLE'S REACH DRIVE
Practice Address - Street 2:BLUE RIDGE COMMUNITY COLLEGE
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731-4728
Practice Address - Country:US
Practice Address - Phone:828-692-7068
Practice Address - Fax:828-696-9722
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211194Medicaid
NC079U2Medicare UPIN