Provider Demographics
NPI:1629388608
Name:SMITH, JERALEE A (PT)
Entity Type:Individual
Prefix:MS
First Name:JERALEE
Middle Name:A
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 1:215 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4415
Mailing Address - Country:US
Mailing Address - Phone:951-237-6215
Mailing Address - Fax:
Practice Address - Street 1:709 W 5TH ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4209
Practice Address - Country:US
Practice Address - Phone:903-583-8551
Practice Address - Fax:903-583-2900
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1102499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist