Individual
MICHAEL J SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
801 POLE LINE RD W, TWIN FALLS, ID 83301-5810
(208) 814-2495
Mailing address
801 POLE LINE RD W, TWIN FALLS, ID 83301-5810
(208) 814-2495
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-4850
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT-4850
STATE LICENSE
ID
Enumeration date
09/19/2016
Last updated
02/15/2018
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