Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 030246 | NY |
NPI | 1003140088 |
---|---|
Provider Name | Jennifer Smith |
First Address | Brooklyn, NY 11206-5996 |
Second Address | Wilton, CT 06897-4429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2009 |
Last Update Date | 14/02/2011 |