Individual
MARK DAVID SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
2600 S WISCONSIN AVE STE A, RICE LAKE, WI 54868-7527
(715) 855-0430
(715) 236-3615
Mailing address
517 E CLAIREMONT AVE, EAU CLAIRE, WI 54701-6479
(715) 855-0408
(715) 855-0409
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6121024
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40312100
—
WI
Enumeration date
05/04/2006
Last updated
12/16/2024
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