Healthcare Provider Details

I. General information

NPI: 1346977303
Provider Name (Legal Business Name): CHELSA REGAIL SMITH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11286 BOYETTE RD STE 101
RIVERVIEW FL
33569-8022
US

IV. Provider business mailing address

13020 N TELECOM PARKWAY
TEMPLE TERRRACE FL
33637-6326
US

V. Phone/Fax

Practice location:
  • Phone: 813-978-9700
  • Fax: 813-558-6185
Mailing address:
  • Phone: 813-978-9700
  • Fax: 813-558-6185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT22523
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: