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General NPI Number Information
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NPI Number | 1750759627
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Entity Type | Individual
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Provider Name | VALERIE LOUISE SMITH A.T.C., L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 1100 N COLE RD
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City | BOISE
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State | ID
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Zip | 83704-8644
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Country | US
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Telephone | 208-375-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 4245 S PALATINO AVE
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City | MERIDIAN
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State | ID
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Zip | 83642-9265
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Country | US
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Telephone | 520-730-5512
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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 | ATR-LAT-LIC-1007
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MAS-2635
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License Number State | ID
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