MEDICARE: DR. CHRISTOPHER JOEL SMALLEY DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251S0007X	Sports Physical Therapist	302668	CA

General Provider Information

NPI Number	:	1184402422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER JOEL SMALLEY DPT

Provider Business Mailing Address
First Line	:	2900 S SEPULVEDA BLVD UNIT 212
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-4173
Country	:	US
Telephone Number	:	908-499-7932
Fax Number	:

Provider Business Practice Location Address
First Line	:	11461 W WASHINGTON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-6025
Country	:	US
Telephone Number	:	424-543-4336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	09/18/2023

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