Provider Demographics
NPI:1841248655
Name:SMIT, STEPHANIE LYNN-KING (PT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN-KING
Last Name:SMIT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7727 BLUEBIRD DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-7962
Mailing Address - Country:US
Mailing Address - Phone:616-667-3166
Mailing Address - Fax:
Practice Address - Street 1:1535 44TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4481
Practice Address - Country:US
Practice Address - Phone:616-530-1977
Practice Address - Fax:616-530-2140
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist