Healthcare Provider Details

I. General information

NPI: 1528582467
Provider Name (Legal Business Name): CARTER D SMITH MD, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date: 03/25/2025
Reactivation Date: 04/30/2025

III. Provider practice location address

1215 LEE ST BOX 800713
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

1215 LEE ST BOX 800713
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5700
  • Fax: 434-924-1736
Mailing address:
  • Phone: 434-924-5700
  • Fax: 434-924-1736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP17335
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17335
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: