Individual
PETER SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
415 CENTER ST, BRIDGEWATER, MA 02324-1309
(508) 697-6902
Mailing address
415 CENTER ST, BRIDGEWATER, MA 02324-1309
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AH748AT
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AH748AT
ALLIED HEALTH STATE LICENSE
MA
Enumeration date
11/30/2017
Last updated
06/16/2018
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