Provider Demographics
NPI:1912918137
Name:SMITH, JENNIFER LEIGH (PT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:75-5699 KOPIKO ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3651
Mailing Address - Country:US
Mailing Address - Phone:808-329-7744
Mailing Address - Fax:808-334-1608
Practice Address - Street 1:75-5699 KOPIKO ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3651
Practice Address - Country:US
Practice Address - Phone:808-329-7744
Practice Address - Fax:808-334-1608
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-3910225200000X
MI55010112562251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic