Provider Demographics
NPI:1932191962
Name:SMITH-SOCARIS, AMANDA (PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:SMITH-SOCARIS
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 1:609 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WATKINS GLEN
Mailing Address - State:NY
Mailing Address - Zip Code:14891-1302
Mailing Address - Country:US
Mailing Address - Phone:607-535-7475
Mailing Address - Fax:607-535-7445
Practice Address - Street 1:609 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1302
Practice Address - Country:US
Practice Address - Phone:607-535-7475
Practice Address - Fax:607-535-7445
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0189512251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02226644Medicaid
NYDD0413Medicare ID - Type Unspecified
NYP48438Medicare UPIN