Provider Demographics
NPI:1679597850
Name:SMITH, JERRY RICHARD (PT, DPT, ATC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:RICHARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 302178
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00803-2178
Mailing Address - Country:US
Mailing Address - Phone:340-779-4678
Mailing Address - Fax:340-715-4678
Practice Address - Street 1:BARBEL PLZ
Practice Address - Street 2:#8 NEW QUARTER
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-4600
Practice Address - Country:US
Practice Address - Phone:340-779-4678
Practice Address - Fax:340-715-4678
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI121225100000X
FLPT22484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist