Individual
MRS. JESSICA LAUREN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
N10565 GRANDVIEW LN, IRONWOOD, MI 49938-9622
(906) 932-5990
Mailing address
N10565 GRANDVIEW LN, IRONWOOD, MI 49938-9622
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
5501016821
MI
225100000X
Physical Therapist
Primary
05012478A
IN
Other
Enumeration date
06/13/2018
Last updated
04/12/2019
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