Provider Demographics
NPI:1518187814
Name:SMITH, JENNIFER METEVIER (MPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:METEVIER
Last Name:SMITH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JOAN
Other - Last Name:METEVIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12526 RUTHDALE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6735
Mailing Address - Country:US
Mailing Address - Phone:972-814-4519
Mailing Address - Fax:
Practice Address - Street 1:12526 RUTHDALE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-6735
Practice Address - Country:US
Practice Address - Phone:972-814-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1127769171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor