Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT 28927 | CA |
NPI | 1023082294 |
---|---|
Provider Name | Mrs. Deborah Smith |
First Address | Ventura, CA 93003-3464 |
Second Address | Ventura, CA 93003-3464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 22/02/2008 |