Individual
SHANNON K SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
12 1ST ST, RIVERHEAD, NY 11901-4602
(631) 769-4969
Mailing address
12 1ST ST, RIVERHEAD, NY 11901-4602
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
012899
NY
Other
Enumeration date
09/07/2024
Last updated
09/07/2024
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