1376938621 NPI number — KRISTIN MICHELLE SMILEY PT

Table of content: KRISTIN MICHELLE SMILEY PT (NPI 1376938621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376938621 NPI number — KRISTIN MICHELLE SMILEY PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMILEY
Provider First Name:
KRISTIN
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STOLTS
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376938621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 FOWLER AVE.
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
BERWICK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-759-2000
Provider Business Mailing Address Fax Number:
570-585-1321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3750 ROUTE 220 HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUGHESVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-759-2000
Provider Business Practice Location Address Fax Number:
570-585-1321
Provider Enumeration Date:
04/03/2015

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:  PT008312L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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