Provider Demographics
NPI:1679863245
Name:SMITH, JASMINE MARTIN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:MARTIN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 LEXINGTON DR
Mailing Address - Street 2:STE H
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6646
Mailing Address - Country:US
Mailing Address - Phone:601-910-7300
Mailing Address - Fax:601-910-7071
Practice Address - Street 1:105 LEXINGTON DR
Practice Address - Street 2:H
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6645
Practice Address - Country:US
Practice Address - Phone:601-910-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4561208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00209229Medicaid