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General NPI Number Information
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NPI Number | 1902645880
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Entity Type | Individual
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Provider Name | JOSEPH BALLESTEROS SMITH PT
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Gender | Male
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Dates
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Enumeration Date | 05/21/2024
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 7230 S LAND PARK DR STE 105
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City | SACRAMENTO
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State | CA
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Zip | 95831-3657
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Country | US
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Telephone | 916-393-0497
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Fax | 916-393-5567
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Provider Business Mailing Address
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Address Line | 9033 LAGUNA SPRINGS WAY
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City | ELK GROVE
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State | CA
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Zip | 95758-5326
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Country | US
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Telephone | 916-430-9188
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 306010
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License Number State | CA
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