Provider Demographics
NPI:1548678444
Name:SMITH, CASEY M (PT, DPT, CSCS, WCS)
Entity type:Individual
Prefix:DR
First Name:CASEY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT, DPT, CSCS, WCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9211 FOREST HILL AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6874
Mailing Address - Country:US
Mailing Address - Phone:804-985-1234
Mailing Address - Fax:833-389-1702
Practice Address - Street 1:9211 FOREST HILL AVE STE 103
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-6874
Practice Address - Country:US
Practice Address - Phone:804-985-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist