Provider Demographics
NPI:1285911057
Name:SMITH, MARCY R (PT)
Entity type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7153 SALMON RUN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519
Mailing Address - Country:US
Mailing Address - Phone:315-524-1000
Mailing Address - Fax:315-524-1049
Practice Address - Street 1:7153 SALMON RUN CIR
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:NY
Practice Address - Zip Code:14519-9623
Practice Address - Country:US
Practice Address - Phone:315-524-1000
Practice Address - Fax:315-524-1049
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist