Provider Demographics
NPI:1083929798
Name:SMITH, JENNIFER NOBLE (MSPT, OCS)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NOBLE
Last Name:SMITH
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Gender:F
Credentials:MSPT, OCS
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Mailing Address - Street 1:1011 BOWLES AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2395
Mailing Address - Country:US
Mailing Address - Phone:636-343-9555
Mailing Address - Fax:636-343-9556
Practice Address - Street 1:1011 BOWLES AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2395
Practice Address - Country:US
Practice Address - Phone:636-343-9555
Practice Address - Fax:636-343-9556
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO117945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist