Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 02870 | LA |
NPI | 1083641989 |
---|---|
Provider Name | Mr. Jamie George Smith |
First Address | Gonzales, LA 70707-1991 |
Second Address | Gonzales, LA 70737-4637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 10/09/2007 |