Provider Demographics
NPI:1558539015
Name:SMITH, JENNIFER ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ROSE DHU RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-3313
Mailing Address - Country:US
Mailing Address - Phone:912-920-3450
Mailing Address - Fax:
Practice Address - Street 1:125 ROSE DHU RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-3313
Practice Address - Country:US
Practice Address - Phone:912-920-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2019-10-14
Deactivation Date:2011-03-24
Deactivation Code:
Reactivation Date:2019-10-14
Provider Licenses
StateLicense IDTaxonomies
GAPT0036762251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics