| NPI | 1225392335 |
|---|---|
| Former Name | JESSICA LYNNE SMITH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 11645) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT02139) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2020-04-07 |