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General NPI Number Information
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NPI Number | 1457977142
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Entity Type | Organization
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Legal Business Name | SMITH PHYSICAL THERAPY AND PERFORMANCE STUDIO, APC
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Dates
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Enumeration Date | 06/18/2020
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 7433 HERSCHEL AVE STE 2
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City | LA JOLLA
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State | CA
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Zip | 92037-5175
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Country | US
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Telephone | 858-683-3292
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Fax | 858-228-5956
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Provider Business Mailing Address
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Address Line | 7433 HERSCHEL AVE STE 2
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City | LA JOLLA
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State | CA
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Zip | 92037-5175
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Country | US
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Telephone | 858-683-3292
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Fax | 858-228-5956
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Authorized Official
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Title or Position | CEO, DOCTOR OF PHYSICAL THERAPY
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Name | KAYLEE MARIE SMITH
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Credential | DPT
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Telephone | 858-683-3292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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