Provider Demographics
NPI:1457977142
Name:SMITH PHYSICAL THERAPY AND PERFORMANCE STUDIO, APC
Entity type:Organization
Organization Name:SMITH PHYSICAL THERAPY AND PERFORMANCE STUDIO, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:KAYLEE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:858-683-3292
Mailing Address - Street 1:7433 HERSCHEL AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5175
Mailing Address - Country:US
Mailing Address - Phone:858-683-3292
Mailing Address - Fax:858-228-5956
Practice Address - Street 1:7433 HERSCHEL AVE STE 2
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5175
Practice Address - Country:US
Practice Address - Phone:858-683-3292
Practice Address - Fax:858-228-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy