Individual
FAITH NICOLE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA, LAT, ATC
Contact information
Practice address
904 MUNICIPAL DR, BRANDON, MS 39042-2973
(601) 724-7310
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 264-6000
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
PTA-7032
MS
2255A2300X
Athletic Trainer
Primary
AT0500
MS
Other
Enumeration date
08/29/2014
Last updated
08/12/2022
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