Healthcare Provider Details

I. General information

NPI: 1912302019
Provider Name (Legal Business Name): KATHERINE SMITH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE FALCIONI

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MICHIGAN AVE
GRAYLING MI
49738-1312
US

IV. Provider business mailing address

1353 CHARLES BRINK RD
GAYLORD MI
49735-7644
US

V. Phone/Fax

Practice location:
  • Phone: 989-348-5461
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT013822
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501302549
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: