Individual
BRODY W SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
22951 HIGHWAY CC, REVERE, MO 63465-1136
(660) 216-9328
Mailing address
22951 HIGHWAY CC, REVERE, MO 63465-1136
(660) 216-9328
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
01/13/2023
Last updated
01/13/2023
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