Provider Demographics
NPI:1932110236
Name:BOXDORFER SMITH, KATIE ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:KATIE
Middle Name:ANN
Last Name:BOXDORFER SMITH
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 1:12608 LAMPLIGHTER SQUARE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128
Mailing Address - Country:US
Mailing Address - Phone:314-842-4222
Mailing Address - Fax:314-842-9393
Practice Address - Street 1:12608 LAMPLIGHTER SQUARE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128
Practice Address - Country:US
Practice Address - Phone:314-842-4222
Practice Address - Fax:314-842-9393
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO217051833Medicare ID - Type Unspecified