Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 00131102 | CO |
NPI | 1013374289 |
---|---|
Provider Name | Jason Smith |
First Address | Denver, CO 80209-4148 |
Second Address | Denver, CO 80209-4148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2016 |
Last Update Date | 26/01/2016 |