Individual
JEREMY TYRELL SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7840 JEWELLA AVE, SHREVEPORT, LA 71108-5004
(318) 687-0881
Mailing address
2948 MILAM ST, SHREVEPORT, LA 71103-2115
(225) 210-0640
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LA8462
LA
Other
Enumeration date
07/24/2025
Last updated
07/24/2025
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