Individual
JENNIFER SMART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2200 IRONWOOD PL, COEUR D ALENE, ID 83814-2610
(208) 667-6486
Mailing address
9024 N BALDWIN CT, HAYDEN, ID 83835-9840
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
P1 60560540
WA
225200000X
Physical Therapy Assistant
Primary
PTA-4248
ID
Other
Enumeration date
09/08/2015
Last updated
09/08/2015
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