Healthcare Provider Details

I. General information

NPI: 1942766993
Provider Name (Legal Business Name): KAITLYN MUELLER SMITH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN ANN MUELLER

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MAMARONECK AVE
HARRISON NY
10528-1633
US

IV. Provider business mailing address

PO BOX 22747
NEW YORK NY
10087-2747
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-1145
  • Fax: 203-618-1721
Mailing address:
  • Phone: 203-869-1145
  • Fax: 203-618-1721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055671
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number296344
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: