Provider Demographics
NPI:1144586090
Name:LE JACQ-SMITH, CHRISTINE (PT)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:LE JACQ-SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 AIMES WAY
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-1260
Mailing Address - Country:US
Mailing Address - Phone:508-636-9165
Mailing Address - Fax:
Practice Address - Street 1:8 AIMES WAY
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-1260
Practice Address - Country:US
Practice Address - Phone:508-636-9165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6652225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist