Healthcare Provider Details

I. General information

NPI: 1588648463
Provider Name (Legal Business Name): KRISTIN LYNN SMITH PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 PINEVILLE MATTHEWS RD STE 540
CHARLOTTE NC
28226-4749
US

IV. Provider business mailing address

8700 PINEVILLE MATTHEWS RD STE 540
CHARLOTTE NC
28226-4749
US

V. Phone/Fax

Practice location:
  • Phone: 704-751-0532
  • Fax: 704-544-1104
Mailing address:
  • Phone: 704-751-0532
  • Fax: 704-544-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11220
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP15576
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP17127
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: