Individual
MARK GERARD SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
225 PHYSICIANS PARK, SUITE 101, POPLAR BLUFF, MO 63901-3956
(573) 778-9348
(573) 686-4870
Mailing address
4273 KEATON CROSSING BLVD, O FALLON, MO 63368-8220
(636) 206-4225
(636) 422-1051
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
2014039475
MO
Other
Enumeration date
11/19/2014
Last updated
07/30/2019
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