Individual
TYLER JONATHON SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT
Contact information
Practice address
2409 N CRIBBENS AVE, BOISE, ID 83713-5239
(208) 484-2047
Mailing address
1910 UNIVERSITY DR, MS 1020, BOISE, ID 83725-0002
(208) 426-3944
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-261
ID
Other
Enumeration date
02/28/2007
Last updated
07/08/2007
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