Provider Demographics
NPI:1902141401
Name:SMITH, FELICIA LIANE (MSPT)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:LIANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2839 SW 87TH DR STE 10
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-9376
Mailing Address - Country:US
Mailing Address - Phone:352-505-6665
Mailing Address - Fax:352-226-8744
Practice Address - Street 1:2839 SW 87TH DR STE 10
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-9376
Practice Address - Country:US
Practice Address - Phone:352-505-6665
Practice Address - Fax:352-226-8744
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35224225100000X
PAPT022506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist