Provider Demographics
NPI:1427293422
Name:SMITH, DONNA MARIE (BS)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7458 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1715
Mailing Address - Country:US
Mailing Address - Phone:315-376-7588
Mailing Address - Fax:
Practice Address - Street 1:18564 US ROUTE 11
Practice Address - Street 2:SUITE 5
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5900
Practice Address - Country:US
Practice Address - Phone:315-786-7202
Practice Address - Fax:315-786-1524
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020764-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist