Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | ||
Y | 2251G0304X | Physical Therapist - Geriatrics | 1174110 | TX |
NPI | 1083195838 |
---|---|
Provider Name | Annmarie Smith |
First Address | Wylie, TX 75098-6997 |
Second Address | Farmersville, TX 75442-3427 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2018 |
Last Update Date | 28/08/2018 |