Provider Demographics
NPI:1699071233
Name:NAIR, SMITHA S (PT)
Entity type:Individual
Prefix:
First Name:SMITHA
Middle Name:S
Last Name:NAIR
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 1:363 ROUTE 111
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-4756
Mailing Address - Country:US
Mailing Address - Phone:631-406-6526
Mailing Address - Fax:631-406-6529
Practice Address - Street 1:363 ROUTE 111
Practice Address - Street 2:SUITE 107
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4756
Practice Address - Country:US
Practice Address - Phone:631-406-6526
Practice Address - Fax:631-406-6529
Is Sole Proprietor?:No
Enumeration Date:2011-01-30
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
030644-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400059038Medicare PIN