Individual
MARK EDWARD SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1120 FALCON DR, KENNETT, MO 63857-3825
(573) 888-1150
Mailing address
807 TEAL CV, KENNETT, MO 63857-9122
(573) 344-0503
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2011000736
MO
Other
Enumeration date
04/07/2015
Last updated
04/07/2015
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