Provider Demographics
NPI:1124159652
Name:SMITH, CHAD I (PT)
Entity type:Individual
Prefix:MR
First Name:CHAD
Middle Name:
Last Name:SMITH
Suffix:I
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12115 SHERATON LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-1613
Mailing Address - Country:US
Mailing Address - Phone:513-347-9999
Mailing Address - Fax:513-346-7299
Practice Address - Street 1:12115 SHERATON LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1613
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:513-346-7299
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-011731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0214940Medicaid
OH366632Medicare PIN
OHH216720Medicare PIN