Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT013031 | GA |
NPI | 1003321704 |
---|---|
Provider Name | Jessica Ariel Smith |
First Address | Gainesville, GA 30501-2545 |
Second Address | Gainesville, GA 30501-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2017 |
Last Update Date | 05/12/2017 |