Individual
MRS. KIMBERLY ANN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
120 N TOWER RD, CARBONDALE, IL 62901-1929
(618) 549-3355
Mailing address
106 TIMBER TRL, CARTERVILLE, IL 62918-2377
(615) 473-8161
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.004882
IL
225200000X
Physical Therapy Assistant
3732
TN
Other
Enumeration date
11/04/2006
Last updated
12/31/2020
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