MEDICARE: JESSE NEWBAKER SMARTT DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305210317	VA

General Provider Information

NPI Number	:	1366891897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE NEWBAKER SMARTT DPT

Provider Business Mailing Address
First Line	:	7400 BEAUFONT SPRINGS DR
Second Line	:	SUITE 120
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-5556
Country	:	US
Telephone Number	:	804-320-2220
Fax Number	:

Provider Business Practice Location Address
First Line	:	7400 BEAUFONT SPRINGS DR
Second Line	:	SUITE 120
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-5556
Country	:	US
Telephone Number	:	804-320-2220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2016
Last Update Date	:	09/07/2021

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