Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT 22747 | CA |
NPI | 1033586888 |
---|---|
Provider Name | Alexandra Nuttall-Smith |
First Address | Hermosa Beach, CA 90254-4229 |
Second Address | Hermosa Beach, CA 90254-4229 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2015 |
Last Update Date | 27/08/2015 |