Provider Demographics
NPI:1730791922
Name:SMITH, KERI LYNN (CMT)
Entity type:Individual
Prefix:MRS
First Name:KERI
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44380 AGAWAM TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-6484
Mailing Address - Country:US
Mailing Address - Phone:571-435-6555
Mailing Address - Fax:
Practice Address - Street 1:21631 RIDGETOP CIR STE 225
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-4289
Practice Address - Country:US
Practice Address - Phone:571-435-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019004322225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist