Individual
MATT SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
3261 W STATE RD, SAINT BONAVENTURE, NY 14778
(716) 375-2230
Mailing address
1604 WILHOIT AVE, LEWIS CENTER, OH 43035-7933
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
003747
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/01/2016
Last updated
12/05/2018
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