Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 005243 | IA |
N | 225100000X | Physical Therapist | 3126 | NE |
NPI | 1003171489 |
---|---|
Provider Name | Mrs. Rebecca Smith |
First Address | Waukee, IA 50263-5022 |
Second Address | Waukee, IA 50263-5022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2012 |
Last Update Date | 21/10/2013 |