Healthcare Provider Details

I. General information

NPI: 1043205131
Provider Name (Legal Business Name): HEIDI LABORE SMITH PT, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date: 03/22/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

1827 E SUPERIOR ST
DULUTH MN
55812-2044
US

IV. Provider business mailing address

4325 PITT ST
DULUTH MN
55804-1962
US

V. Phone/Fax

Practice location:
  • Phone: 218-724-3400
  • Fax: 218-728-7991
Mailing address:
  • Phone: 218-525-2095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1094
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2113
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: