Provider Demographics
NPI:1790997708
Name:SMITH, EDWARD HUNTINGTON JR (MA, ATC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:HUNTINGTON
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:MA, ATC
Other - Prefix:
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Mailing Address - Street 1:3417 TIMBERBROOK CT.
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122
Mailing Address - Country:US
Mailing Address - Phone:317-892-3630
Mailing Address - Fax:317-297-8086
Practice Address - Street 1:7001 W 56TH STREET
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254
Practice Address - Country:US
Practice Address - Phone:317-808-5208
Practice Address - Fax:317-297-8086
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN36000056A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer