Healthcare Provider Details

I. General information

NPI: 1811442700
Provider Name (Legal Business Name): JENNIFER SMITH PT, DPT, OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2016
Last Update Date: 08/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33100 CLEVELAND CLINIC BLVD
AVON OH
44011-1390
US

IV. Provider business mailing address

13748 BROOKHAVEN BLVD
BROOKPARK OH
44142-2647
US

V. Phone/Fax

Practice location:
  • Phone: 440-695-4000
  • Fax: 440-695-4198
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT.014739
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: