Provider Demographics
NPI:1649286071
Name:SMITH, BARBARA MERRITT (PT PHYS THERAPIST)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:MERRITT
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT PHYS THERAPIST
Other - Prefix:MISS
Other - First Name:BARBARA
Other - Middle Name:LEIGH
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT PHY THERAPIST
Mailing Address - Street 1:855 LARKIN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-8515
Mailing Address - Country:US
Mailing Address - Phone:831-724-6863
Mailing Address - Fax:
Practice Address - Street 1:15 PENNY LANE
Practice Address - Street 2:SUITE 4
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076
Practice Address - Country:US
Practice Address - Phone:831-724-8235
Practice Address - Fax:831-724-9099
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105322251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEO608ZMedicare PIN
OPT105320Medicare ID - Type Unspecified
CACP932Medicare PIN