Provider Demographics
NPI:1720164767
Name:SMITH, JENNIFER KIRK (PT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KIRK
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:140 EXECUTIVE DR.
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651
Mailing Address - Country:US
Mailing Address - Phone:864-963-9229
Mailing Address - Fax:
Practice Address - Street 1:140 EXECUTIVE DRIVE
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651
Practice Address - Country:US
Practice Address - Phone:864-963-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4198225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ342588560Medicare PIN