Individual
JASON KYLE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
575 PROFESSIONAL DR STE 370, LAWRENCEVILLE, GA 30046-3334
(678) 205-5420
(678) 205-5420
Mailing address
4025 MCGINNIS FERRY RD APT 1702, SUWANEE, GA 30024-7224
(704) 609-6367
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT012904
GA
Other
Enumeration date
06/07/2017
Last updated
06/07/2017
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