Provider Demographics
NPI:1861792384
Name:SMITH, EVETTE MARIA (PT, MSPT)
Entity type:Individual
Prefix:MISS
First Name:EVETTE
Middle Name:MARIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901
Mailing Address - Country:US
Mailing Address - Phone:607-737-4713
Mailing Address - Fax:845-210-3036
Practice Address - Street 1:100 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901
Practice Address - Country:US
Practice Address - Phone:607-737-4713
Practice Address - Fax:845-210-3036
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist