Individual
IRIS SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2127 ROSE MAY DR, FORNEY, TX 75126-6587
(512) 229-8373
Mailing address
500 W 3RD AVE STE 6, CORSICANA, TX 75110-4564
(903) 872-5925
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2111732
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2111732
THE STATE OF TEXAS
TX
Enumeration date
07/29/2018
Last updated
07/29/2018
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