Provider Demographics
NPI:1932676715
Name:SMITH, KONAR
Entity Type:Individual
Prefix:
First Name:KONAR
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 EDENBRIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANGUS
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L0M1B3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 EDENBRIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:ANGUS
Practice Address - State:ONTARIO
Practice Address - Zip Code:L0M1B3
Practice Address - Country:CA
Practice Address - Phone:705-716-5421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer