Individual
MR. A THEODORE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, L.AC.
Contact information
Practice address
1600 WEST 24TH STREET, COLORADO MENTAL HEALTH INSTITUTE AT PUEBLO, PUEBLO, CO 81003
(719) 761-1486
Mailing address
1600W 24TH ST, PUEBLO, CO 81003-1411
(719) 546-4081
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3118
CO
Other
Enumeration date
11/22/2010
Last updated
12/29/2015
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