1992019871 NPI number — MRS. SARAH KRISTIN SMITH D.P.T

Table of content: MRS. SARAH KRISTIN SMITH D.P.T (NPI 1992019871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992019871 NPI number — MRS. SARAH KRISTIN SMITH D.P.T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
SARAH
Provider Middle Name:
KRISTIN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
D.P.T
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POOR
Provider Other First Name:
SARAH
Provider Other Middle Name:
KRISTEN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992019871
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 RAPIDAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOCUST GROVE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22508-2026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-850-8435
Provider Business Mailing Address Fax Number:
540-854-0369

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9445 ZACHARY TAYLOR HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNIONVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22567-2126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-854-0367
Provider Business Practice Location Address Fax Number:
540-854-0369
Provider Enumeration Date:
08/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305206574 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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