Basic Information
| Provider Information | |||||||||
| NPI: | 1184950867 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 83 N MILLER RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443333729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308651600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 105 SUGAR CAMP CIR | ||||||||
| Address2: | SUITE 221 | ||||||||
| City: | OAKWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454091962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372273174 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2009 | ||||||||
| LastUpdateDate: | 09/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 012430 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.