Provider Demographics
NPI:1992734354
Name:SMITH, WESLEY WARREN (ATC)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:WARREN
Last Name:SMITH
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31749 LA TIENDA RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4010
Mailing Address - Country:US
Mailing Address - Phone:818-575-9241
Mailing Address - Fax:818-865-8786
Practice Address - Street 1:31749 LA TIENDA RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4010
Practice Address - Country:US
Practice Address - Phone:818-575-9241
Practice Address - Fax:818-865-8786
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer