Provider Demographics
NPI:1740553825
Name:SMITH, JEFFREY W (PT)
Entity type:Individual
Prefix:PROF
First Name:JEFFREY
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:101 RIVER RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:JEFFERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70121-4222
Mailing Address - Country:US
Mailing Address - Phone:504-828-7696
Mailing Address - Fax:504-828-8935
Practice Address - Street 1:101 RIVER RD
Practice Address - Street 2:SUITE 112
Practice Address - City:JEFFERSON
Practice Address - State:LA
Practice Address - Zip Code:70121-4222
Practice Address - Country:US
Practice Address - Phone:504-828-7696
Practice Address - Fax:504-828-8935
Is Sole Proprietor?:No
Enumeration Date:2012-02-20
Last Update Date:2012-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA07827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist