Individual
LISA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
NINE 14TH AVE WEST, POLSON, MT 59860-5321
(406) 883-4378
Mailing address
PO BOX 727, SONOITA, AZ 85637-0727
(307) 272-4815
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
11516A
AZ
225200000X
Physical Therapy Assistant
Primary
13146
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2A05978680
ARIZONA FINGER PRINT CLEARANCE CARD
AZ
Enumeration date
10/25/2017
Last updated
10/25/2017
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