Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 006339 | KY |
Y | 2251P0200X | Physical Therapist - Pediatrics | 006339 | KY |
NPI | 1033589270 |
---|---|
Provider Name | Keegan Whitney Smith |
First Address | Lexington, KY 40503-3564 |
Second Address | Lexington, KY 40503-3564 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2015 |
Last Update Date | 21/04/2020 |