Provider Demographics
NPI:1366891897
Name:SMARTT, JESSE NEWBAKER (DPT)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:NEWBAKER
Last Name:SMARTT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 BEAUFONT SPRINGS DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-5556
Mailing Address - Country:US
Mailing Address - Phone:804-320-2220
Mailing Address - Fax:
Practice Address - Street 1:7400 BEAUFONT SPRINGS DR
Practice Address - Street 2:SUITE 120
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-5556
Practice Address - Country:US
Practice Address - Phone:804-320-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist