Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1902826142 |
---|---|
Provider Name | Mrs. Deborah Marie Gray-Smith |
First Address | Congress, AZ 85332-1421 |
Second Address | Phoenix, AZ 85012-1839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |