Provider Demographics
NPI:1184769770
Name:SMITH, JEFFREY BRIAN (ATC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:BRIAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:SUNDERLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01375-9600
Mailing Address - Country:US
Mailing Address - Phone:413-665-4204
Mailing Address - Fax:
Practice Address - Street 1:131 COMMONWEALTH AVE
Practice Address - Street 2:BOYDEN ROOM 9
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01003-9253
Practice Address - Country:US
Practice Address - Phone:413-545-2866
Practice Address - Fax:413-545-3150
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer