Individual
KENNETH W SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
240 RIDGEWOOD AVE, HOLLY HILL, FL 32117-4944
(386) 492-2958
Mailing address
33 CIRCLE DR, DAYTONA BEACH, FL 32117-1807
(386) 253-2654
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA40128
FL
Other
Enumeration date
01/08/2011
Last updated
02/28/2013
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