Provider Demographics
NPI:1447634555
Name:SMITH, JAMIE L (PTA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:PASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:904 RICHARD ALAN RD
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-8881
Mailing Address - Country:US
Mailing Address - Phone:870-941-8986
Mailing Address - Fax:
Practice Address - Street 1:3450 W 34TH AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5508
Practice Address - Country:US
Practice Address - Phone:870-534-7392
Practice Address - Fax:870-534-7297
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3981225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant