Individual
JENNIFER SMIDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4020 COLUMBUS AVE, ANDERSON, IN 46013-5010
(765) 641-7605
(765) 641-7607
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05012098A
IN
225100000X
Physical Therapist
10970
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
48351750
—
CO
Enumeration date
01/21/2008
Last updated
07/14/2016
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