Individual
MICHELLE KAY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
5704 LONGEST DR, SOUTH BELOIT, IL 61080-9256
(608) 751-4672
Mailing address
5704 LONGEST DR, SOUTH BELOIT, IL 61080-9256
(608) 751-4672
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1266-019
WI
Other
Enumeration date
01/16/2008
Last updated
11/17/2014
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