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General NPI Number Information
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NPI Number | 1558431338
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Entity Type | Individual
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Provider Name | JAYSON PHILLIPS SMITH PT
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1015 LEE DR SUITE 1 B
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City | CLARKSDALE
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State | MS
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Zip | 38614-3698
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Country | US
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Telephone | 662-624-2466
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Fax | 662-624-4876
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Provider Business Mailing Address
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Address Line | 2822 PINNACLE DR
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City | SOUTHAVEN
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State | MS
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Zip | 38672-6324
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Country | US
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Telephone | 334-233-4960
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Fax | 662-624-4876
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT3961
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License Number State | MS
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