Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 2148 | NM |
NPI | 1093827396 |
---|---|
Provider Name | Ginnie Smith |
First Address | Alamogordo, NM 88310-9492 |
Second Address | Alamogordo, NM 88310-6437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
79339 | (05) | NM |