Provider Demographics
NPI:1538687108
Name:SMITH, JOCELYN J (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3220 AMY DONOVAN PLZ APT 10103
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-3720
Mailing Address - Country:US
Mailing Address - Phone:915-256-3616
Mailing Address - Fax:
Practice Address - Street 1:3220 AMY DONOVAN PLAZA
Practice Address - Street 2:APT 10103
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758
Practice Address - Country:US
Practice Address - Phone:915-256-3616
Practice Address - Fax:915-256-3616
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT69472081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine