Provider Demographics
NPI:1811169758
Name:SMITH, AMY M (PT)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-213-0478
Mailing Address - Fax:
Practice Address - Street 1:1735 ROUTE 9
Practice Address - Street 2:SUITE 101
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2421
Practice Address - Country:US
Practice Address - Phone:518-373-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2010-08-24
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Provider Licenses
StateLicense IDTaxonomies
NY016696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400020620Medicare PIN