Individual
CHARISSA BETHE'L SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1767 BLUE SKY DR, IDAHO FALLS, ID 83402-4802
(208) 525-7770
(208) 525-7778
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-3841
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0506221
NV
2255A2300X
Athletic Trainer
AT-386
ID
Other
Enumeration date
09/24/2009
Last updated
10/02/2018
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