Healthcare Provider Details

I. General information

NPI: 1568544997
Provider Name (Legal Business Name): KEVIN MICHAEL SMITH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SUNNY ISLE PROFESSIONAL BUILDING SUITE 6F
CHRISTIANSTED VI
00823-5100
US

IV. Provider business mailing address

PO BOX 5100 SUNNY ISLE
CHRISTIANSTED VI
00823-5100
US

V. Phone/Fax

Practice location:
  • Phone: 340-772-9557
  • Fax: 340-772-9558
Mailing address:
  • Phone: 340-772-9557
  • Fax: 340-772-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number78
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: