Individual
JASON SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
18561 N 59TH AVE STE 117, GLENDALE, AZ 85308-1256
(623) 322-0654
(623) 322-0664
Mailing address
15681 N 29TH ST, PHOENIX, AZ 85032-3726
(602) 932-2159
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6742
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6742
LICENSE #
AZ
Enumeration date
08/30/2006
Last updated
07/21/2022
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