Provider Demographics
NPI:1871815753
Name:SMITH, STEVEN JAMES (DAT, MPA, AT, ATC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:DAT, MPA, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-2203
Mailing Address - Country:US
Mailing Address - Phone:734-936-0719
Mailing Address - Fax:734-763-8056
Practice Address - Street 1:1200 S STATE ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-2203
Practice Address - Country:US
Practice Address - Phone:734-936-0719
Practice Address - Fax:734-763-8056
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer