Provider Demographics
NPI:1184402422
Name:SMALLEY, CHRISTOPHER JOEL (DPT)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOEL
Last Name:SMALLEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 S SEPULVEDA BLVD UNIT 212
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4173
Mailing Address - Country:US
Mailing Address - Phone:908-499-7932
Mailing Address - Fax:
Practice Address - Street 1:11461 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-6025
Practice Address - Country:US
Practice Address - Phone:424-543-4336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3026682251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports