Healthcare Provider Details

I. General information

NPI: 1033208988
Provider Name (Legal Business Name): FELICE SMITH BSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 N MAIN ST
WARSAW NY
14569-1023
US

IV. Provider business mailing address

2496 DODGESON RD
ALEXANDER NY
14005-9785
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-0090
  • Fax:
Mailing address:
  • Phone: 585-547-3522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012727-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: