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General NPI Number Information
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NPI Number | 1003351347
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Entity Type | Individual
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Provider Name | LISA SMITH ATC
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Gender | Female
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 1600 CITY PARK ESPLANADE
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City | DENVER
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State | CO
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Zip | 80206-1429
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Country | US
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Telephone | 720-423-8340
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Fax |
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Provider Business Mailing Address
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Address Line | 9282 W TEXAS DR
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City | LAKEWOOD
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State | CO
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Zip | 80232-5100
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Country | US
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Telephone | 303-910-1360
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 833868099
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License Number State | CO
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