Individual
MISS RACHEAL MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
1950 45TH AVE, MUNSTER, IN 46321-3927
(219) 924-7316
Mailing address
425 W 93RD PL, APT 116, CROWN POINT, IN 46307-2291
(815) 238-8415
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001883A
IN
Other
Enumeration date
12/14/2011
Last updated
12/14/2011
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