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General NPI Number Information
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NPI Number | 1750465100
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Entity Type | Individual
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Provider Name | KATHLEEN MARY SMITH P.T.
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 133 W MAIN ST SUITE 120
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City | NORTHVILLE
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State | MI
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Zip | 48167-1520
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Country | US
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Telephone | 248-347-1188
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Fax | 248-347-1252
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Provider Business Mailing Address
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Address Line | 1111 RONALD REAGAN PKWY
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City | AVON
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State | IN
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Zip | 46123-7085
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Country | US
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Telephone | 317-217-3070
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Fax | 317-217-3073
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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 | 5501002674
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05009688A
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License Number State | IN
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