Healthcare Provider Details

I. General information

NPI: 1679350102
Provider Name (Legal Business Name): ALLISON SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 KEMPTON ST
SPRING VALLEY CA
91977-5810
US

IV. Provider business mailing address

9146 EASTPOINTE CT
ELK GROVE CA
95624-3936
US

V. Phone/Fax

Practice location:
  • Phone: 619-479-4790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number304844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: