Healthcare Provider Details

I. General information

NPI: 1831447077
Provider Name (Legal Business Name): KIMBERLY M SMITH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY ROBACZEWSKI

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W TOUHY AVE
CHICAGO IL
60646-1275
US

IV. Provider business mailing address

625 ENTERPRISE DR
OAK BROOK IL
60523-8813
US

V. Phone/Fax

Practice location:
  • Phone: 773-774-4291
  • Fax: 773-774-4527
Mailing address:
  • Phone: 630-575-6250
  • Fax: 630-575-7450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070-019378
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: