Individual
JESSIE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1157 N 300 W STE 201, PROVO, UT 84604-6124
(801) 357-1200
Mailing address
1157 N 300 W STE 201, PROVO, UT 84604-6124
(801) 357-1200
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
7384705-4810
UT
Other
Enumeration date
01/03/2017
Last updated
02/06/2017
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