Provider Demographics
NPI:1346417235
Name:SMITH, JEFFREY LEE (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LEE
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LORDVALE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH GRAFTON
Mailing Address - State:MA
Mailing Address - Zip Code:01536-1124
Mailing Address - Country:US
Mailing Address - Phone:508-839-5247
Mailing Address - Fax:
Practice Address - Street 1:40 LORDVALE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01536-1124
Practice Address - Country:US
Practice Address - Phone:508-839-5247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-11
Last Update Date:2008-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0301582OtherMEDCAID
MASMY68222Medicare Oscar/Certification