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Individual

TYLIANS T SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPTA

Contact information

Practice address
12544 FEE FEE RD, SAINT LOUIS, MO 63146
(850) 532-3690
Mailing address
12544 FEE FEE RD, SAINT LOUIS, MO 63146-3808
(850) 532-3690

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2017038679
MO

Other

Enumeration date
04/18/2019
Last updated
04/22/2019
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