Healthcare Provider Details

I. General information

NPI: 1386821858
Provider Name (Legal Business Name): KERRY FIRMIN SMITH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 N TYNDALL PKWY
CALLAWAY FL
32404-6132
US

IV. Provider business mailing address

1518 MACKENZIE CT
LYNN HAVEN FL
32444-5451
US

V. Phone/Fax

Practice location:
  • Phone: 609-321-4262
  • Fax:
Mailing address:
  • Phone: 850-571-5652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT32156
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24625
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: