Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 5501002937 | MI |
Y | 2251P0200X | Physical Therapist - Pediatrics | 5501002937 | MI |
NPI | 1023532249 |
---|---|
Provider Name | Jennifer Lynn Smith |
First Address | Middleville, MI 49333-8203 |
Second Address | Middleville, MI 49333-8203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2017 |
Last Update Date | 30/07/2017 |