Individual
JARED GLEN SMIDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
10971
CO
225100000X
Physical Therapist
11-06384
KS
225100000X
Physical Therapist
Primary
CP004494T
MO
Other
Enumeration date
01/16/2008
Last updated
09/10/2021
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