Individual
DR. MATTHEW CHARLEW SMITLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DAT, LAT, ATC
Contact information
Practice address
875 PERIMETER DR # MS 2401, MOSCOW, ID 83844-7462
(208) 885-0349
(208) 885-5929
Mailing address
320 OPAL BROOK DR, ELIZABETHTON, TN 37643-7462
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-642
ID
2255A2300X
Athletic Trainer
LAT-2518
NC
Other
Enumeration date
05/16/2014
Last updated
09/02/2020
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