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General NPI Number Information
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NPI Number | 1790997708
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Entity Type | Individual
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Provider Name | EDWARD HUNTINGTON SMITH JR. M.A., A.T.C.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7001 W 56TH STREET
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City | INDIANAPOLIS
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State | IN
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Zip | 46254
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Country | US
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Telephone | 317-808-5208
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Fax | 317-297-8086
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Provider Business Mailing Address
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Address Line | 3417 TIMBERBROOK CT.
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City | DANVILLE
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State | IN
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Zip | 46122
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Country | US
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Telephone | 317-892-3630
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Fax | 317-297-8086
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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 | 36000056A
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License Number State | IN
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