Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251N0400X | Physical Therapist - Neurology | PT 14015 | CA |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT 14015 | CA |
NPI | 1497052500 |
---|---|
Provider Name | Ms. Julie Clare Smith |
First Address | Sebastopol, CA 95472-4323 |
Second Address | Sebastopol, CA 95472-4323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2011 |
Last Update Date | 25/02/2011 |