Individual
MR. LARRY EUGENE SMITH JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1612 OAK ST, KENOVA, WV 25530-1118
(304) 544-1097
Mailing address
1612 OAK ST, KENOVA, WV 25530-1118
(304) 544-1097
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA #1451
WV
Other
Enumeration date
04/30/2009
Last updated
04/30/2009
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