Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT4493 | MS |
NPI | 1003174566 |
---|---|
Provider Name | Rashad Smith |
First Address | Canton, MS 39046-3761 |
Second Address | Brandon, MS 39047-6376 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2012 |
Last Update Date | 30/11/2016 |