Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PTL.0014957 | CO |
Y | 2251S0007X | Physical Therapist - Sports | PTL.0014957 | CO |
NPI | 1518487057 |
---|---|
Provider Name | Ellen P Smith |
First Address | Boulder, CO 80301-2709 |
Second Address | Boulder, CO 80309-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2017 |
Last Update Date | 10/11/2017 |