Healthcare Provider Details

I. General information

NPI: 1104636331
Provider Name (Legal Business Name): CARLEE SMITH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3876 HIGHWAY 90
PACE FL
32571-1014
US

IV. Provider business mailing address

6414 QUINTETTE RD
PACE FL
32571-9771
US

V. Phone/Fax

Practice location:
  • Phone: 448-227-7071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT40816
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: