Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT 40486 | CA |
NPI | 1003242462 |
---|---|
Provider Name | Ashley Smith |
First Address | Hawthorne, CA 90250-6670 |
Second Address | El Segundo, CA 90245-4401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2013 |
Last Update Date | 12/10/2018 |