Individual
MR. TIM M SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3200 GREENWOOD RD., SHREVEPORT, LA 71103
(318) 212-4450
Mailing address
408 WEAVERS WAY, BOSSIER CITY, LA 71111-2097
(318) 617-6523
Taxonomy
Speciality
Code
Description
License number
State
224Y00000X
Clinical Exercise Physiologist
Primary
CEP.CE0198
LA
Other
Enumeration date
11/04/2011
Last updated
11/04/2011
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