Provider Demographics
NPI:1831153949
Name:SMIT, RENE (RPT)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:
Last Name:SMIT
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-1808
Mailing Address - Country:US
Mailing Address - Phone:863-699-6929
Mailing Address - Fax:
Practice Address - Street 1:104 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-1808
Practice Address - Country:US
Practice Address - Phone:863-699-6929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0005726208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY909EOtherBLUE CROSS BLUE SHIELD
FLY909EOtherBLUE CROSS BLUE SHIELD