Provider Demographics
NPI:1215998182
Name:SMART, JOSHUA CAMILLE (LATC, LMT)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:CAMILLE
Last Name:SMART
Suffix:
Gender:M
Credentials:LATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BIRDSEYE AVE
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-1669
Mailing Address - Country:US
Mailing Address - Phone:207-227-3689
Mailing Address - Fax:
Practice Address - Street 1:22 BIRDSEYE AVE
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-1669
Practice Address - Country:US
Practice Address - Phone:207-492-0346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0705020462255A2300X
MEMT3902246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other