Provider Demographics
NPI:1316969348
Name:SMITH, KIMBERLY L (PT, CHT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-3319
Mailing Address - Country:US
Mailing Address - Phone:215-699-2844
Mailing Address - Fax:215-699-2845
Practice Address - Street 1:102 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-3319
Practice Address - Country:US
Practice Address - Phone:215-699-2844
Practice Address - Fax:215-699-2845
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001966E2251H1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA655502N1AMedicare ID - Type UnspecifiedPHYSICAL THERAPIST