Healthcare Provider Details

I. General information

NPI: 1720825102
Provider Name (Legal Business Name): JESSICA SMITH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 S FAIR OAKS AVE
PASADENA CA
91105-2625
US

IV. Provider business mailing address

5416 FAIR AVE APT 1419
NORTH HOLLYWOOD CA
91601-2737
US

V. Phone/Fax

Practice location:
  • Phone: 626-389-9300
  • Fax:
Mailing address:
  • Phone: 707-688-1822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: