MEDICARE: KELSEY SMITH DPT

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
1	225100000X	Physical Therapist	PT016063	GA

General Provider Information

NPI Number	:	1457089823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY SMITH DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-702-4389
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 LONG BRANCH RD UNIT 102
Second Line	:
City	:	DAHLONEGA
State	:	GA
Zip	:	30533-7132
Country	:	US
Telephone Number	:	706-864-0200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	01/20/2026

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