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General NPI Number Information
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NPI Number | 1548001787
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Entity Type | Individual
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Provider Name | CARLEY JORDAN SMITH
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Gender | Female
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Dates
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Enumeration Date | 06/03/2024
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 489 STATE RD
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City | WEST TISBURY
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State | MA
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Zip | 02575-5497
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Country | US
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Telephone | 508-693-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 429 WOODARDS FORD RD
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City | CHESAPEAKE
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State | VA
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Zip | 23322-4308
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Country | US
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Telephone | 757-559-3690
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305216404
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License Number State | VA
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