Provider Demographics
NPI:1124328455
Name:SMILIE, JARRETT (LMT, NASM-CPT)
Entity type:Individual
Prefix:MR
First Name:JARRETT
Middle Name:
Last Name:SMILIE
Suffix:
Gender:M
Credentials:LMT, NASM-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-9675
Mailing Address - Country:US
Mailing Address - Phone:832-326-8816
Mailing Address - Fax:
Practice Address - Street 1:603 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-9675
Practice Address - Country:US
Practice Address - Phone:832-326-8816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT110903225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist