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NPI Code Detail

MEDICARE: CRYSTAL IRENE SMITH

MEDICARE: CRYSTAL IRENE SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2305205226VA

General Provider Information

NPI Number : 1255661807
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL IRENE SMITH
Provider Business Mailing Address
First Line : 801 CARRINGTON AVE
Second Line :
City : CAPITOL HEIGHTS
State : MD
Zip : 20743-1846
Country : US
Telephone Number : 240-988-4329
Fax Number :
Provider Business Practice Location Address
First Line : 801 CARRINGTON AVE
Second Line :
City : CAPITOL HEIGHTS
State : MD
Zip : 20743-1846
Country : US
Telephone Number : 240-988-4329
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2010
Last Update Date : 01/04/2010

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Directions to “ CRYSTAL IRENE SMITH ” Practice Location

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