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General NPI Number Information
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NPI Number | 1073257275
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Entity Type | Individual
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Provider Name | ASHLEY WAGNER SMITH LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 04/24/2022
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Last Update Date | 04/24/2022
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Provider Practice Location Address
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Address Line | 14001 HURRICANE BLVD
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City | IRVINGTON
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State | AL
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Zip | 36544-3071
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Country | US
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Telephone | 267-664-2519
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Fax |
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Provider Business Mailing Address
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Address Line | 2877 S SHERWOOD DR
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City | MOBILE
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State | AL
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Zip | 36606-2418
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Country | US
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Telephone | 267-664-2519
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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 | 1743
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License Number State | AL
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