Healthcare Provider Details

I. General information

NPI: 1750100756
Provider Name (Legal Business Name): JENNIFER SMITH LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6099 RIVERSIDE DR STE 207
DUBLIN OH
43017-2004
US

IV. Provider business mailing address

6099 RIVERSIDE DR STE 207
DUBLIN OH
43017-2004
US

V. Phone/Fax

Practice location:
  • Phone: 740-590-1940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6022
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: