Individual
MR. LEROY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
200 W CONSTANCE RD, SUFFOLK, VA 23434-4413
(757) 539-8744
(757) 539-8764
Mailing address
4413 BIRCH RD, PORTSMOUTH, VA 23703-1501
(757) 483-1419
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1008775
VA
Other
Enumeration date
06/05/2008
Last updated
06/05/2008
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