Provider Demographics
NPI:1912216730
Name:SMITH, KRISTIN MARY (PT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:MARY
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:GREFRATH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2849 LOCKPORT RD
Mailing Address - Street 2:
Mailing Address - City:OAKFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14125-9753
Mailing Address - Country:US
Mailing Address - Phone:585-813-1003
Mailing Address - Fax:
Practice Address - Street 1:2849 LOCKPORT RD
Practice Address - Street 2:
Practice Address - City:OAKFIELD
Practice Address - State:NY
Practice Address - Zip Code:14125-9753
Practice Address - Country:US
Practice Address - Phone:585-813-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021563-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist