Provider Demographics
NPI:1780964536
Name:SMITH, KRISTIN M (PT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:M
Other - Last Name:ORENCHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:208 S ARCH ST
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-3519
Mailing Address - Country:US
Mailing Address - Phone:724-628-7288
Mailing Address - Fax:724-628-7299
Practice Address - Street 1:208 S ARCH ST
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3519
Practice Address - Country:US
Practice Address - Phone:724-628-7288
Practice Address - Fax:724-628-7299
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist