Individual
MR. DWAYNE PATRICK SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1103 KOEN CREEK CT. APT. A, PARK HILLS, MO 63601
(573) 747-7059
Mailing address
1103 KOEN CREEK CT. APT. A, PARK HILLS, MO 63601
(573) 747-7059
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
116882
MO
Other
Enumeration date
05/09/2007
Last updated
07/08/2007
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