MEDICARE: MRS. CARRIE J SMITH PT

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	002365	WV

General Provider Information

NPI Number	:	1871684696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARRIE J SMITH PT

Provider Business Mailing Address
First Line	:	400 ASSOCIATION DR STE 102
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25311-1298
Country	:	US
Telephone Number	:	304-388-1724
Fax Number	:	304-388-1721

Provider Business Practice Location Address
First Line	:	3200 MACCORKLE AVE SE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25304-1297
Country	:	US
Telephone Number	:	304-388-5432
Fax Number	:

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	01/31/2024

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