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General NPI Number Information
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NPI Number | 1477099000
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Entity Type | Individual
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Provider Name | LIZZ VANWILGEN SMITH PT
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Gender | Female
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Dates
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Enumeration Date | 01/06/2017
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 1133 BROADWAY STE 1211
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City | NEW YORK
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State | NY
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Zip | 10010-7963
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Country | US
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Telephone | 917-912-3980
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Fax |
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Provider Business Mailing Address
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Address Line | 146 PIERREPONT ST APT 8C
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City | BROOKLYN
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State | NY
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Zip | 11201-2840
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Country | US
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Telephone | 917-912-3980
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 014141-0
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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