Individual
DIANA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
1875 N LAKEWOOD DR STE 101, COEUR D ALENE, ID 83814-4928
(208) 667-6264
(208) 664-4313
Mailing address
1450 NORTHWEST BLVD STE 106, COEUR D ALENE, ID 83814-5605
(208) 772-6609
(208) 664-4313
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1584
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807043800
—
ID
Enumeration date
08/31/2006
Last updated
04/08/2020
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