Provider Demographics
NPI:1508006925
Name:SMITH, COSETTE T (PT)
Entity Type:Individual
Prefix:MS
First Name:COSETTE
Middle Name:T
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:970 MONUMENT STREET
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272
Mailing Address - Country:US
Mailing Address - Phone:310-573-9553
Mailing Address - Fax:310-573-9533
Practice Address - Street 1:970 MONUMENT STREET
Practice Address - Street 2:SUITE 207
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272
Practice Address - Country:US
Practice Address - Phone:310-573-9553
Practice Address - Fax:310-573-9533
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35354225100000X
CA353542251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist