Basic Information
| Provider Information | |||||||||
| NPI: | 1558700393 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | RODWELL | ||||||||
| MiddleName: | ARTHUR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14005 ARTHUR AVE. UNIT #10 | ||||||||
| Address2: | |||||||||
| City: | PARAMOUNT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626347111 | ||||||||
| FaxNumber: | 5626347111 | ||||||||
| Practice Location | |||||||||
| Address1: | 3875 S WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900621105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232904352 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2013 | ||||||||
| LastUpdateDate: | 08/07/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner |
No ID Information.