Individual
MRS. JESSICA E SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
11169-024
WI
225100000X
Physical Therapist
Primary
11169
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972742831
—
WI
Enumeration date
02/16/2009
Last updated
06/29/2016
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