Provider Demographics
NPI:1568755585
Name:SMITH, JAMAR DOMONIC (DPT)
Entity Type:Individual
Prefix:DR
First Name:JAMAR
Middle Name:DOMONIC
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 MALCOLM X AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032
Mailing Address - Country:US
Mailing Address - Phone:301-965-0348
Mailing Address - Fax:202-318-8492
Practice Address - Street 1:2810 WALTERS LANE SUITE 100
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747
Practice Address - Country:US
Practice Address - Phone:301-965-0348
Practice Address - Fax:202-318-8492
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist