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General NPI Number Information
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NPI Number | 1073436200
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Entity Type | Individual
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Provider Name | JASON MATTHEW SMITH MS, ATC, LAT
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Gender | Male
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Dates
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Enumeration Date | 08/03/2026
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Last Update Date | 08/03/2026
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Provider Practice Location Address
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Address Line | 1130 SMITH FIELDHOUSE
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City | PROVO
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State | UT
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Zip | 84602-2246
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Country | US
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Telephone | 801-422-2946
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Fax |
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Provider Business Mailing Address
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Address Line | 688 W 800 N
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City | PROVO
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State | UT
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Zip | 84601-1517
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Country | US
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Telephone | 956-222-6872
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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 | AT2562
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License Number State | TX
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