Individual
LEE MARTIN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS,PT
Contact information
Practice address
4411 S ADAMS ST, MARION, IN 46953-5349
(765) 674-4455
(765) 674-3577
Mailing address
4411 S ADAMS ST, MARION, IN 46953-5349
(765) 674-4455
(765) 674-3577
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05001874A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000352159
ANTHEM PROVIDER NUMBER
IN
01
—
05001874A
PHYSICAL THERAPY LICENSE
IN
Enumeration date
03/24/2007
Last updated
07/08/2007
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