Individual
NATHAN WARREN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
4115 EA 240 NO, RIGBY, ID 83442-5879
(208) 745-1422
Mailing address
4115 EA 240 NORTH, RIGBY, ID 83442-5879
(208) 745-1422
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-180
ID
Other
Enumeration date
11/20/2006
Last updated
07/08/2007
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