Healthcare Provider Details

I. General information

NPI: 1558332122
Provider Name (Legal Business Name): BERYL ANN SMITH P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLAZA ORTHOPAEDIC CENTER FOR SPINAL & PEDIATRIC CARE
DAYTON OH
45404-1815
US

IV. Provider business mailing address

2031 VIENNA PKWY
DAYTON OH
45459-1356
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3010
  • Fax: 937-641-5003
Mailing address:
  • Phone: 937-439-1868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-10782
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2896324
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT-10782
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number2896324
License Number StateTN
# 5
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT-10782
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2896324
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: