Jennifer Smiddy, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05012098A Issued in IN

Practice address

4020 Columbus Ave
Anderson, IN 46013-5010

Phone

(765) 641-7605

Fax

(765) 641-7607

NPI assigned

Jan 21, 2008

Sex

Female

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 1

Other names 1

• Jennifer Koons Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rebound Sports & Physical Therapy, P.C.

  • Physical Therapist
  • Loveland, CO
  • NPI 1780680926
  NPD

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

{
    "created_epoch": "1200873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468454400000",
    "number": "1497931497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223",
            "fax_number": "630-759-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 COLUMBUS AVE",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460135010",
            "telephone_number": "765-641-7605",
            "fax_number": "765-641-7607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMIDDY",
        "first_name": "JENNIFER",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-21",
        "last_updated": "2016-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "10970",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05012098A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "48351750",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "KOONS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Truman Skinner, RBT
• Melena A. Slaven, NCC, CRC, LMHC
• Rebekah Sloan, BCBA
• Sarah Lynette Sloan, MS, RD, CD
• Haley Ruth Slusher, RD, LD
• Ashley L Smith, RBT
• Carol Webb Smith
• Christopher Tyler Smith, DPT
• Garry L Smith, DDS
• Laura Smith

• Physical Therapist in Anderson, IN
• Providers in Anderson, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2016; 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.