Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 1137990 | TX |
NPI | 1184936122 |
---|---|
Provider Name | Patricia Grant Smith |
First Address | Fort Worth, TX 76132-3921 |
Second Address | Fort Worth, TX 76132-3921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2010 |
Last Update Date | 16/12/2020 |