Healthcare Provider Details

I. General information

NPI: 1124602008
Provider Name (Legal Business Name): FLYNT JOSEPH SMATHERS ACSM CEP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6678 RIVERSIDE DR
DUBLIN OH
43017-9503
US

IV. Provider business mailing address

954 BURR OAK BLVD
NELSONVILLE OH
45764-9742
US

V. Phone/Fax

Practice location:
  • Phone: 740-610-1440
  • Fax:
Mailing address:
  • Phone: 740-753-3681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number606839
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: