Provider Demographics
NPI:1023056223
Name:SMITH, ISABELLA (PT)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ISABELLA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:72880 FRED WARING DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-9373
Mailing Address - Country:US
Mailing Address - Phone:760-340-4036
Mailing Address - Fax:760-340-4036
Practice Address - Street 1:72880 FRED WARING DR
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-9373
Practice Address - Country:US
Practice Address - Phone:760-340-4036
Practice Address - Fax:760-340-4036
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT32761OtherPHYSICAL THERAPY LICENSE
CA0PT327610Medicare ID - Type UnspecifiedMEDICARE NUMBER