Provider Demographics
NPI:1083641989
Name:SMITH, JAMIE GEORGE (MSPT, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:GEORGE
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1991
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70707-1991
Mailing Address - Country:US
Mailing Address - Phone:225-647-1515
Mailing Address - Fax:225-647-5151
Practice Address - Street 1:2012 S. BURNSIDE AVE.
Practice Address - Street 2:SUITE B
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4637
Practice Address - Country:US
Practice Address - Phone:225-647-1515
Practice Address - Fax:225-647-5151
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA028702251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic