Provider Demographics
NPI:1316287246
Name:SMOCK, SHUREE GANGLOFF (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:SHUREE
Middle Name:GANGLOFF
Last Name:SMOCK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:SHUREE
Other - Middle Name:N/A
Other - Last Name:GANGLOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 50004
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91115-0004
Mailing Address - Country:US
Mailing Address - Phone:626-683-8536
Mailing Address - Fax:626-683-8236
Practice Address - Street 1:200 E DEL MAR BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2544
Practice Address - Country:US
Practice Address - Phone:626-683-8236
Practice Address - Fax:626-683-8236
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist