Individual
MR. WALTER K SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MED, LAT, ATC
Contact information
Practice address
1001 E 17TH ST, ASSEMBLY HALL, BLOOMINGTON, IN 47408-1590
(812) 855-3621
(812) 855-1810
Mailing address
6416 E COX DR, BLOOMINGTON, IN 47408-9517
(812) 336-2661
(812) 855-1810
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36000057A
IN
Other
Enumeration date
10/07/2005
Last updated
01/25/2012
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