Jeremy Smith

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

License

070.016666 Issued in IL

Practice address

1920 Football Dr
Lake Forest, IL 60045-4829

Phone

(847) 739-5405

NPI assigned

May 16, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376784000000",
    "number": "1184830812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1920 FOOTBALL DR",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600454829",
            "telephone_number": "847-739-5405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 FOOTBALL DR",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600454829",
            "telephone_number": "847-739-5405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JEREMY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-16",
        "last_updated": "2013-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096.002695",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "IL",
            "license": "070.016666",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS STATE LICENSE",
            "identifier": "070.016666",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL LICENSE PT",
            "identifier": "070.016666",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS STATE LICENSE",
            "identifier": "096.002695",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL LICENSE ATC",
            "identifier": "096.002695",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rosamaria Slominski, PT
• Smalltalk Speech Pathology LLC
• Paul Smiley, PSY.D., ABCP
• Corrina Smith, MD
• Jack Oscar Reed Smith, PT, DPT
• Steven Daniel Smith, P.T.
• Colleen Marie Smyrniotis, APN
• Kim R Sobinsky, M.D.
• Christine Marie Somberg, ACNS-BC
• Michael Jon Sommerfeld, MD

• Sports Physical Therapist in Lake Forest, IL
• Providers in Lake Forest, IL by specialty
• Sports Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.