Healthcare Provider Details

I. General information

NPI: 1255170080
Provider Name (Legal Business Name): KAITLYN L SMITH DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7165 COLUMBIA GATEWAY DR STE A
COLUMBIA MD
21046-2145
US

IV. Provider business mailing address

773 ST REGIS AVE
BLOOMINGDALE NY
12913-2114
US

V. Phone/Fax

Practice location:
  • Phone: 443-441-0616
  • Fax:
Mailing address:
  • Phone: 518-637-8212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberAPPLIED
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: